A review of the development of interventional devices for mitral valve repair with the implantation of artificial chords

Figures

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  FIGURE 1. (A) Atrial and sagittal views of mitral valve. Left, P1-A1 was anterolateral, P3-A3 was posteromedial. Right, Sagittal view showing subvalvular supporting structures. A indicates anterior; P, posterior; and PM, papillary muscle (Ali et al., 2020). (B) Mitral Valve Anatomical Map. (C) Comparison of artificial and native chordae, reoperation after 12 years (Salvador et al., 2008).

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  FIGURE 2. The development process of artificial chorda implantation technology.

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  FIGURE 3. (A) Regurgitant jet produced by chordal rupture attached to posterior leaflet as seen from right thoracotomy. (B) Prosthetic chorda attached to flailing leaflet. (C) Pulley stitch completed in the ventricular wall. Tension adjusted on chorda, restoring leaflet position. (D) Prosthetic chorda anchored at the atrial wall and excess length excised (Morris et al., 1964).

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  FIGURE 4. Transapical NeoChord mitral valve repair (Colli et al., 2018a).

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  FIGURE 5. ChordArt implant. There were nitinol leaflets and papillary muscle anchors with an ePTFE chord (Rogers and Bolling, 2021; Weber et al., 2021).

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  FIGURE 6. (A) The NeoChord DS 1000 system (Rucinskas et al., 2014; Fernando et al., 2020), (B) The Harpoon TSD-5 system (Gammie et al., 2016), (C) The MitralStitch system (Wang et al., 2018). Courtesy of (http://www.dinovamedtech.com).

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  FIGURE 7. (A) The MitralStitch™ system device, Valve Stitcher and Sutures Knotter. The suture and pledget were preloaded in the head of the Valve Stitcher. (B) Mechanism of artificial chordae implantation by Valve Stitcher. (C) (Left) Intraprocedural two dimensional and color TEE image showing severe MR due to P2 region leaflet prolapse. (right) TTE view showing the implanted artificial chordae (arrow) (Wang S. et al., 2022).

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  FIGURE 8. (A) The CardioMech Device. Courtesy of (CardioMech, Oslo, Norway) (Rogers and Bolling, 2021). (B) The Pipeline Device. Courtesy of (Pipeline Medical Technologies, Inc. a wholly-owned subsidiary of W.L. Gore & Associates, Inc., Santa Rosa, California) (Fiocco et al., 2019). (C) The Valtech V-Chordal Device. Courtesy of (Valtech, Or Yehuda, Israel) (Maisano et al., 2011).

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  FIGURE 9. (A) A rupture in an implanted NeoChord below the knot and the pledget (Heuts et al., 2019). (B) Surgical view and histologic analysis of the resected ruptured neochords (Grinberg et al., 2019a).

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  FIGURE 10. (A) The “loop” artificial chordal Implantation Technology (Duran and Pekar, 2003; Kudo et al., 2014), (B,C) Macro and SEM images of the partial fracture of the ePTFE loop (Castillo et al., 2013; Kudo et al., 2014).

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  FIGURE 11. The anterior leaflets showed thickening chordae tendineae (white arrows). Longitudinal sections through the ruptured ePTFE suture. Large areas of mineralization were seen within the graft interstices and in the areas surrounding the graft (asterisk) (stain: hematoxylin and eosin, tissue viewed with polarized light, original magnification = ×1.6) (Butany et al., 2004).