Effect Of Less Invasive LV Remodeling With A Myocardial Anchoring System On Mitral Regurgitation
C. Muneretto1, L. Labrousse2, I. Skalsky3
1Ospedale Civile, Brescia, Italy, 2Hopital Haut Leveque, Bordeaux, France, 3Na Homolka Hospital, Prague, Czech Republic
Ischemic mitral regurgitation often originates from ventricular dysfunction. However, most recent technical innovations have focused on repair of the mitral valve apparatus rather than restoring ventricular geometry. Additionally, these less invasive therapies for the mitral valve have been shown to have a significant rate of MR recurrence. Historically, surgical volume reduction techniques to treat LV dilation are highly invasive, requiring both sternotomy and cardiopulmonary bypass. The Myocardial Anchoring System is used in post-AMI ischemic cardiomyopathy to plicate the myocardial scar and resize the LV to a more normal physiological state. Thus, we hypothesize that the use of the anchoring System may have beneficial effects on mitral valve function and resolve ischemic mitral regurgitation.
The Myocardial Anchoring System utilizes a series of micro-anchor pairs to exclude myocardial scar from the LV cavity. The anchor implantation is performed off pump and without ventriculotomy. A hybrid transcatheter delivery system is currently in EU clinical trials. We retrospectively analyzed the effects of volume reduction and geometry changes following scar plication to assess changes in mitral valve tenting parameters in 20 patients. By the trial design, only patients with mild to moderate MR were included for analysis from a broader multicenter safety and efficacy study of the anchoring system.
Demonstrates improvement in hemodynamic, clinical parameters and all 3 measures of mitral valve geometry when evaluated at 6 months compared to baseline as shown in Table 1.
Clinical and hemodynamic parameters significantly improved 6 months post MI scar plication with a Myocardial Anchoring System. These favorable changes are also accompanied with an improvement in mitral valve tenting and decrease in annular circumference and coaptation depth. Consequently, this technique imparts changes to the LV size and geometry that may positively impact mitral valve function and secondary mitral regurgitation in ischemic dilated cardiomyopathy. With the recent advent of a hybrid transcatheter approach, this system may be a promising less invasive adjunct for treating ischemic mitral regurgitation in the future.