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A Novel Method of Percutaneous Mitral Valve Repair for Ischemic Mitral Regurgitation

Paul Sorajja, MD, FACC^_*, Rick A. Nishimura, MD, FACC^_*,_*, Jess Thompson, MD^_*, Kenton Zehr, MD

^_* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
Department of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

^_* Reprint requests and correspondence: Dr. Rick A. Nishimura, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota 55906 (Email: rick.nishimura{at}mayo.edu).

Objectives: This investigation sought to determine the feasibility of a novel method of a percutaneous mitral valve repair.

Background: Percutaneous mitral valve repair has emerged as an alternative therapy for patients with functional mitral regurgitation. However, current methods that rely on cannulation of the coronary sinus may not result in direct reduction of the mitral annulus area due to the superior relationship of the sinus to the annulus.

Methods: A novel device, consisting of helical stainless steel screws connected by a biocompatible tether, was designed for percutaneous mitral valve repair. This device was implanted by implanting the helical screws directly into the myocardium at the posteromedial mitral annulus of 8 anesthetized pigs from the right internal jugular vein.

Results: Implantation of the device resulted in a 19.7 ± 0.1% reduction in mitral annular area and an 18.8 ± 0.1% decrease in the mitral anterior-posterior dimension (both p < 0.05 vs. baseline). This annular reduction persisted at 3-month follow-up. Both the coronary sinus and left circumflex coronary artery remained patent in all animals. There was no evidence of device migration, poor wound healing, or tissue thrombosis at the sites of device implantation.

Conclusions: Percutaneous mitral valve repair targeting the ventricular myocardium from central venous access is feasible. By directly acting on the posteromedial mitral annulus, this methodology targets the mitral annular area most frequently affected by ischemic mitral regurgitation, lessens the risk of coronary artery impingement, promotes coronary sinus patency, and overcomes technical concerns that may arise when the coronary sinus lies significantly superior to the mitral annulus.

Key Words: mitral regurgitation • annuloplasty • percutaneous

Abbreviations and Acronyms   A-P = anterior-posterior dimension   C-C = commissure to commissure dimension   ICE = intracardiac echocardiography   MR = mitral regurgitation   PMVR = percutaneous mitral valve repair

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