New Mitral Annuloplasty Ring Enables Oversizing of Transcatheter Heart Valve and Prevents Central or Paravalvular Leakage
21 August 2016
10 October 2016
10 February 2017 (online)
Background Transcatheter valve-in-ring strategies have been developed to treat recurrent mitral regurgitation (MR) after failing surgical annuloplasty. However, suboptimal THV expansion with consecutive paravalvular leakage (PVL) is a procedure-immanent issue.
Methods A rigid, saddle-shaped ring was cut at four locations. The segments were reconnected with pull-springs, rearranged to the original shape, and covered with a sewing cuff. The length of the annuloplasty ring construct, including extended pull-springs, was defined by the perimeter of an appropriate THV. We deployed a Sapien XT within the new ring, expanded it to its maximum extent, and investigated the geometrical changes.
Results Fluoroscopy confirmed oval, saddle-shaped ring before dilation. After THV implantation, the ring segments spread apart and pull-springs were stretched. The extended ring changed its configuration from “oval” to “round” and anchored the THV leaving no paravalvular or central gaps as potential source for PVL.
Conclusion We developed an expandable annuloplasty ring that is perfectly concerted to THV implantation. This proof-of-concept study revealed no PVL and good oversizing ability that might impact future annuloplasty ring design. Further studies have to evaluate durability and device safety.
Keywordsmitral valve disease - transcatheter aortic valve implantation - valvular heart disease - safety
The data have been presented at the 45th annual meeting of The German Society for Thoracic and Cardiovascular Surgery in February 2016 as an oral presentation with the title: “New, Expandable Mitral Annuloplasty Ring Designed to Prevent Central or Paravalvular Leak and Provide Better THV-Oversizing Capacities,” (Abstract-No.: A-760–0029–00499).
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