Evolving Concepts and Technologies in Mitral Valve Repair

Development of a Simultaneous Cryo-Anchoring and Radiofrequency Ablation Catheter for Percutaneous Treatment of Mitral Valve Prolapse

“…9 Additionally, approximately 6.5% to 9% of all diagnosed cases of MVP result in severe MR, 8,12 requiring treatment to improve quality of life. While myxomatous disease is currently not well understood at the Atrium Ventricle 4 cellular and molecular levels, 9 it is well characterized at the tissue and functional levels.…”

“…Anterior leaflets were chosen for the biomechanical and thermal imaging studies due to their larger and more continuous surface area compared to posterior leaflets, although it is noted that posterior leaflets are more often affected by MVP. 9 The center portion of the leaflets were used and trimmed into rectangular sections (Fig. 8A) approximately 12 mm in the radial direction and 15 mm in the circumferential direction.…”

“…In the past decade, percutaneous treatment of MV disease has received a great deal of interest. 6,9,31 Specifically, the 21 For our purposes, the target of RF ablation is the disrupted or distended collagen architecture of the MV leaflets; collagen has been shown to denature and contract when heated to temperatures greater than 65°C. 42 Using biaxial mechanical testing, we have demonstrated that RF ablation effectively reduces MV leaflet geometry and alters biomechanical compliance in vitro.…”

“…9 The benefit of MV repair is that it preserves the sub-valvular apparatus, consisting of the chords and papillary muscles, as removal of these structures has been associated with detrimental effects on left ventricular shape and performance. 19,46 However, recent rates of repair in those who required MV surgery were as low as 44% in the United States, 39 indicating that the complexity of valve repair makes treatment difficult, and more improved techniques will be necessary to improve repair rates.…”

Therapeutic decision-making for patients with fluctuating mitral regurgitation

“…45,46,60,[64][65][66][67][68] Percutaneous devices used to reshape the mitral annulus can be separated into indirect and direct types; the former are positioned in the coronary sinus, whereas the latter addresses the mitral annulus. Indirect annulopasty involves the placement of a device into the coronary sinus to promote favourable annulus remodelling, thereby optimizing leaflet coapta tion.…”