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Transcervical Transcatheter Mitral Valve Replacement (TMVR): a Proof of Principle.
Cristiano Spadaccio1, Piotr Sonecki1, Ying Sutherland2, Fraser Sutherland1.
1Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom, 2CardioPrecision Ltd, Glasgow, United Kingdom.

OBJECTIVE: Transcatheter mitral valve replacement(TMVR) is emerging as an attractive alternative to mitral surgery. Existing approaches TA and TF have major limitations and pertain to the much larger size of mitral devices and delivery systems in comparison with ‘equivalent’ TAVR devices. We recently developed a device system to provide a transcervical access to cardiac structures through a short incision in the neck and successfully performed first-in-man cases of aortic valve replacement via both transcatheter and standard surgical approaches. We now sought to demonstrate the feasibility of this route for TMVR as the transcervical system allows for visualization and exposure of the dome of the left atrium(LA) similar to routinely used open approaches for MV surgery.
METHODS: Thiel-embalmed human cadavers were used. Transcervical access was obtained with the developed system, LA exposed and purse string suture in the dome of the LA readily placed. A steerable catheter was used to insert a guidewire from the LA into the left ventricle(LV) and a delivery catheter was introduced and manipulated through the MV under echocardiographic guidance. The catheter was removed and atrium closed.
RESULTS: The system provided exposure of LA dome similar to the standard surgical view(FigureA-C) Insertion of guidewire across the MV freely mobile within the LV(FigureD) was confirmed. TMVR delivery catheter passed easily through mitral valve orifice into the LV and appeared to follow a smooth curve from neck to valve with ease of manipulation through the MV, catheter removal and atrial closure under HD screen visualization(Figure E-F).
CONCLUSIONS: Although preliminary the results of this study prove the feasibility of TMVR through a transcervical access. The approach overcomes problems with TA and TF access routes, facilitating delivery of large devices to the MV. The procedure could be performed through a minor incision in the neck avoiding chest disruption and promises significant future benefits in terms of rapid recovery, reduction in complications and early discharge, similar to experience with transcervical aortic valve replacement.

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