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Mitral valve overlay facilitates beating heart transatrial annuloplasty in an acute animal trial.
Philipp Kiefer, Thilo Noack, Marcel Vollroth, Joerg Ender, Friedrich W. Mohr, Joerg Seeburger.
Heart Center Leipzig, Leipzig, Germany.

OBJECTIVE: Transcatheter mitral valve (MV) interventions are of great interest. However, optimal imaging modalities are lacking. We therefore aimed to evaluate 3D rotational angiography (Dyna-CT) for MV imaging and navigation of a transcatheter mitral annuloplasty device.
METHODS: An acute animal swine model (n=6) was established. Pigs were anaesthesized and operated using a three centimeter left-sided mini-thoracotomy through the 4th or 5th intercostal space. 3D rotational angiography using rapid ventricular pacing was performed. A 3D-overlay of the left atrium (LA), the MV-annulus and the MV-leaflets was implemented in the fluoroscopic screen. Additionally, the coronary sinus was marked using a standard pacemaker wire. A transcatheter sutureless annuloplasty band (Cardioband, Valtech-Cardio Ltd) was introduced through an 18F sheath in the left atrium and sequentially anchored to the annulus under 3D model guidance only. After size adjustment, the device was removed and the atrium closed by purse-string suture. Postprocedural Dyna-CT and sacrifice of all pigs where then performed for validation of device-positioning.
RESULTS: All annuloplasty implants could be placed successfully on the posterior MV annulus. In two the band was also attached directly to the hinge of the leaflet however without functional impairment. There was no intraoperative death or iatrogenic damage caused by the flexible delivery system. Postprocedural Dyna-CT and necropsy showed optimal positioning of the annuloplasty device.
CONCLUSIONS: This study highlights the feasibility and further potential of Dyna-CT technology for MV-imaging and guidance of transcatheter mitral valve repair.


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