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Direct Nonplanar Reduction of septolateral Dimensions by a Curvilinear Transvalvular Mitral bridge: Midterm Clinical Result
Valavanur A. Subramanian1, Nirav Patel2, Stepan Cerny3.
1Heart Repair Technologies, Palo Alto, CA, USA, 2Lenoxhill Hospital, New York, NY, USA, 3Na Homolce Hospital, Prague, Czech Republic.

OBJECTIVE: Restrictive annuloplasty for functional Mitral regurgitation (FMR) leads to high early recurrence. A novel transvalvular Mitral Bridge(MB) achieves direct non planer reduction of septolateral diameter while preserving leaflet curvature. This study examines effect of MB in FMR patients.
METHODS: Ten patients had MB implanted for symptomatic FMR (grade 3.5 or greater).Mitral bridge was implanted on cardiopulmonary bypass with cardioplegic arrest via left atrial approach. Standard Echocardiograhic and clinical parameters were measured preoperatively, intraoperatively and postoperatively.
RESULTS: Average MB implantation time was< 8 minutes. No patients required intraoperative reorientation of the bridge.Clinical and echocardiographic follow ups were ,done at predischarge1,3,and 6 months. No MACE{ death,M.I,C.V.A and device related adverse event} was observed . during this period{5.85+= 1.7..{3-8 mo } Eight patients had 0 MR grade at the latest follow up and 2 had mild to moderate paravalvular leak with 0 central MR , one was reoperated at 8 months and had a repair of a pinhole leaflet perforation. LVOT obstruction, Aortic regurgitation and systolic anterior leaflet motion was seen in no patients. Effect of MB on coaptation length, septolateral diameter and transmitral gradient is shown in figure 1.
CONCLUSIONS: Transvalvular mitral bridge implantation is safe and effective in elimination of MR by nonplanar reduction of septolateral diameter and preservation of leaflet curvature.The results are stable over a 6 month period. Potential to be a game changer in the therapy of FMR. Simplicity of the concept and the device is promising for transcatheter adaptation.

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