May 1, 2009
View Full PaperPercutaneous suture edge-to-edge repair of the mitral valve
Key Result
Percutaneous endovascular suture-based double orifice mitral repair achieved an acute reduction in mitral regurgitation severity by ≥1 grade in 60% (9 of 15) of patients, though durability was limited.
Structured PICO
Does percutaneous suture edge-to-edge repair reduce mitral regurgitation severity in patients with MR?
P
Population
15 selected patients with mitral regurgitation undergoing a novel percutaneous suture-based double orifice mitral repair, followed for 30 days.
I
Intervention
Percutaneous endovascular suture-based double orifice mitral repair (edge-to-edge procedure)
O
Outcome
Acute reduction in the severity of MR by ≥ 1 grade and durability at 30 dayssurrogate
First-in-man experience of percutaneous suture-based edge-to-edge mitral valve repair demonstrated feasibility but limited clinical benefit and durability.
Limitations
- Technical difficulties
- Inadequacies of current imaging modalities
- Suture dehiscence
- Clinical benefit was limited and the repair not durable
Abstract
AIMS: To describe a new approach to percutaneous mitral valve repair and an illustrative first-in-man experience, we introduce a suture mediated "double orifice", "edge-to-edge" procedure which can be an effective surgical therapy for mitral regurgitation (MR) in selected patient. METHODS AND RESULTS: We describe a novel percutaneous approach to double orifice mitral repair utilising an intra-cardiac suture based system. The procedure was performed in 15 patients in four international centres. Endovascular suture based double orifice mitral repair was feasible with an acute reduction in the severity of MR by > or = 1 grade in nine of 15 patients. At 30 days improvement in MR appeared durable in six patients. Clinical utility was limited by technical difficulties, the inadequacies of current imaging modalities and suture dehiscence. CONCLUSIONS: Percutaneous endovascular suture based cardiac repair is feasible. However, in utilising the current device clinical benefit was limited and the repair not durable. In the future, similar endovascular approaches may enable more complex cardiac repair.