Preprocedural Planning
Pathologic conditions that affect the mitral annulus (MA), papillary muscle, leaflets, chordae tendineae, left ventricle (LV), and left atrium (LA) can all produce or contribute to mitral regurgitation (MR). [7] The goals of surgical techniques are mainly to correct the etiologic mechanism(s) (eg, prolapsed leaflet, annular dilation) of mitral regurgitation. Broadly, the targets of these surgical techniques include the leaflets, MA, commissures, chordae, papillary muscles, and LV. [8, 9, 10, 11, 12]
Current percutaneous technologies for mitral valve repair (MVR) were developed based on some of the same principles as the standard open approaches. These technologies may be conveniently grouped into the following categories:
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Interventions addressing the leaflets
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Direct annuloplasty
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Indirect annuloplasty (eg, via the coronary sinus [CS])
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Chordal implantation
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LV remodeling
A combination of techniques may be used to obtain the best outcome.
Equipment
Equipment options for leaflet plication have included the following:
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Abbott MitraClip
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Edwards MOBIUS (now abandoned)
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TransCardiac MitraFlex
Equipment used for leaflet ablation includes the following:
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BioSense Webster ThermoCool irrigation ablation electrode
Equipment used as a leaflet space occupier includes the following:
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Cardiosolutions Percu-Pro
Equipment options for the percutaneous mechanical cinching approach to direct annuloplasty have included the following:
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Mitralign Percutaneous Annuloplasty System
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Guided Delivery Systems Accucinch Annuloplasty System
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Millipede system
Equipment options for the percutaneous energy-mediated cinching approach to direct annuloplasty have included the following:
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QuantumCor device
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ReCor device
Equipment options for the hybrid approach to direct annuloplasty have included the following:
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Mitral Solutions Adjustable Annuloplasty Ring
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MiCardia Dynamic Annuloplasty Ring System
Equipment options for the coronary sinus approach to indirect annuloplasty have included the following:
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Edwards MONARC
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Cardiac Dimensions Carillon Mitral Contour System
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Viacor Percutaneous Transvenous Mitral Annuloplasty device
Equipment options for the asymmetrical approach to indirect annuloplasty have included the following:
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Ample PS3 percutaneous septal sinus shortening system (now abandoned)
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St Jude Attune Adjustable Annuloplasty Ring
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National Institutes of Health (NIH) cerclage technology
Equipment options for chordal implantation have included the following:
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TransCardiac MitraFlex
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NeoChord device
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Babic device
Equipment options for left ventricle remodeling have included the following:
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Myocor iCoapsys (now discontinued)
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Mardil BACE (Basal Annuloplasty of the Cardia Externally)
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Mitral regurgitation.
