Preprocedural Planning

Pathologic conditions that affect the mitral annulus, papillary muscle, leaflets, chordae tendineae, left ventricle (LV), and left atrium (LA) can all produce or contribute to mitral regurgitation.^[10]The goals of surgical techniques are mainly to correct the etiologic mechanism(s) (eg, prolapsed leaflet, annular dilatation) of mitral regurgitation. Broadly, the targets of these surgical techniques include the leaflets, mitral annulus, commissures, chordae, papillary muscles, and LV.^{[11, 12, 13, 14, 15]}

Percutaneous technologies for mitral valve repair were developed based on some of the same principles as the standard open approaches. These technologies may be conveniently grouped into the following categories:

Interventions addressing the leaflets
Direct annuloplasty
Indirect annuloplasty (eg, via the coronary sinus)
Chordal implantation
LV remodeling

A combination of techniques may be used to obtain the best outcome.

Equipment

The equipment included below serve as examples of the available devices; a comprehensive list of equipment is beyond the scope of this topic.

Equipment options for leaflet plication include the following:

Abbott MitraClip
TransCardiac MitraFlex

Equipment used for leaflet ablation includes the following:

BioSense Webster ThermoCool irrigation ablation catheter

Equipment used as a leaflet space occupier includes the following:

Cardiosolutions Percu-Pro

Equipment options for the percutaneous mechanical cinching approach to direct annuloplasty include the following:

Mitralign Percutaneous Annuloplasty System
Guided Delivery Systems Accucinch Annuloplasty System
Boston Scientific Millipede system

Equipment options for the percutaneous energy-mediated cinching approach to direct annuloplasty include the following:

QuantumCor device
ReCor device

Equipment options for the hybrid approach to direct annuloplasty include the following:

Mitral Solutions Adjustable Annuloplasty Ring
MiCardia Dynamic Annuloplasty Ring System

Equipment options for the coronary sinus approach to indirect annuloplasty include the following:

Edwards MONARC device
Cardiac Dimensions Carillon Mitral Contour System
Viacor Percutaneous Transvenous Mitral Annuloplasty device

Equipment options for the asymmetrical approach to indirect annuloplasty include the following:

St Jude Medical Attune Adjustable Annuloplasty Ring
National Institutes of Health (NIH) cerclage technology

Equipment options for chordal implantation include the following:

TransCardiac Therapeutics MitraFlex device
NeoChord DS1000 device
Babic device

Equipment options for left ventricle remodeling includes the following:

Mardil BACE (Basal Annuloplasty of the Cardia Externally) device

Technique

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