Transcatheter mitral valve implantation: supra-annular and subvalvular fixation techniques

Loger, Klaas; Lutter, Georg; Huenges, Katharina; Frank, Derk; Groß, Justus; Cremer, Jochen; Attmann, Tim; Morlock, Michael M.; Pokorny, Saskia

doi:10.1093/ejcts/ezy188

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Since the porcine cardiovascular system closely resembles human anatomy and physiology, swine are frequently used as animal models [3][4][5]. Echocardiography has been widely used in different porcine models such as myocardial infarction [6][7][8][9][10]. However, transthoracic echocardiography (TTE) in swine is associated with restrictions due to the keel-shaped thorax and narrow spaced ribs [11].…”

Section: Introductionmentioning

confidence: 99%

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Billig

Zayat

Ebeling

et al. 2020

Int J Cardiovasc Imaging

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This study aimed to determine standard left (LV) and right ventricular (RV) transesophageal echocardiographic (TEE) measurements in swine. Additionally, global myocardial work index (GWI) was estimated using pressure-strain loops (PSL). A comprehensive TEE examination was conducted in ten anesthetized, intubated and mechanically ventilated healthy female German landrace swine, weighing 44 to 57 kg. For GWI calculation, we performed LV and RV segmental strain analysis and used invasively measured LV and RV pressure to obtain PSL. The GWI and further myocardial work indices were calculated from the area of the PSL using commercially available software. Furthermore, hemodynamic measurements were obtained using indwelling catheters. We obtained complete standardized baseline values for left and right ventricular dimensions and function. Biplane LV ejection fraction was 63 ± 7 % and the LV end-diastolic volume was 70.5 ± 5.9 ml. Tissue Doppler estimated peak tricuspid annular systolic velocity was 13.1 ± 1.8 cm/s. The Doppler estimated LV and RV stroke volume index were 75.6 ± 7.2 ml/m2 and 76.7 ± 7.8 ml/m2 respectively. Pulsed wave Doppler derived cardiac output correlated well with cardiac output estimated using the thermodilution method (7.0 ± 1.2 l/min vs. 7.0 ± 1.1 l/min, r = 0.812, p = 0.004). The LV global longitudinal strain was -21.3 ± 3.9 % and the RV global longitudinal strain was -15.4 ± 2.5 %. LV GWI was 1885(1281–2121) mmHg*% and 297 ± 62 mmHg*% for the RV. LV global myocardial work efficiency was 82.6 ± 4 % and 83(72–88) % for the RV. TEE offers sufficient morphological, functional and hemodynamic assessment of the heart in swine. Myocardial contractility and mechanics can be reliably evaluated with the non-invasive GWI derived from echocardiography without additional invasive measures.

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Section: Introductionmentioning

confidence: 99%

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Billig

Zayat

Ebeling

et al. 2020

Int J Cardiovasc Imaging

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“…The existing anchoring systems for TMVR are varied and include two sets of opposing anchors, 3 ventricular anchoring structures, 4 two ventricular paddles, 5 a "champagne corklike" conformation, 6 ventricular graspers, 7 ring fixation, 8,9 apical tether fixation, 10 atrial frame, 11 radial force support fixation, 12 and a supra-annular and ventricular anchoring. 13 Unfortunately, there are sparce clinical data in this newly developed field on TMVR. Nevertheless, the data of the apical tether fixation device look quite promising with 98.4% of 100 patients who had none or trace mitral regurgitation after a 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 To avoid any displacement of the mitral valved stent, Goode and colleagues concluded that the design of transcatheter mitral valves must include an anchoring system that can withstand dynamic pressures in the left heart. 1 The currently available anchoring systems, such as two sets of opposing barbs, 3 ventricular tabs, 4 two ventricular paddles, 5 a "champagne cork-like" hook formation, 6 atrial and ventricular barbs, 7 ring fixation, 8,9 apical tether fixation, 10 supraannular frame, 11 radial force support fixation, 12 supra-annular and ventricular barbs, 13 have shown some success but most devices lack technology to avoid valved stent displacement toward the left atrium and paravalvular leakage. 14 A schematic system of the various TMVR anchoring mechanisms has been already described by Blanke and coworkers.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Mitral Valve Replacement: A Novel Anchor Technology

Liu

Lutter

Knueppel

et al. 2021

Thorac Cardiovasc Surg

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Background Mitral valved stents tend to migrate or to develop paravalvular leakage due to high–left ventricular pressure in this cavity. Thus, this study describes a newly developed mitral valved stent anchoring technology. Methods Based on an existing mitral valved stent, four anchoring units with curved surgical needles were designed and fabricated using three-dimensional (3D) software and print technology. Mitral nitinol stents assembled with four anchoring units were successively fixed on 10 porcine annuli. Mechanical tests were performed with a tensile force test system and recorded the tension forces of the 10 nitinol stents on the annulus. Results The average maximum force was 28.3 ± 5.21 N, the lowest was 21.7 N, and the highest was 38.6 N until the stent lost contact with the annulus; for the break force (zero movement of stent from annulus), the average value was 18.5 ± 6.7 N with a maximum value of 26.9 N and a minimum value of 6.07 N. It was additionally observed that the puncture needles of the anchoring units passed into the mitral annulus in all 10 hearts and further penetrated the myocardium in only one additional heart. The anchoring units enhanced the tightness of the mitral valved stent and did not destroy the circumflex coronary artery, coronary sinus, right atrium, aortic root, or the left ventricular outflow tract. Conclusion The new anchoring units for mitral nitinol stents were produced with 3D software and printing technology; with this new type of anchoring technology, the mitral valved stent can be tightly fixed toward the mitral annulus.

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“…When compared to mechanical valves, this improved valve geometry determines physiological-like haemodynamic that limit platelet adhesion and activation, therefore reducing the need for anticoagulation therapy 37 . The large variety of surgical bioprosthesis available today includes valves that can be placed in the subannular or supraannular position 38 , valves with or without stent-frames 39 , sutureless valves 40 , and valves with different anticalcification treatments 41 .…”

Section: Bioprosthesesmentioning

confidence: 99%

Next-generation tissue-engineered heart valves with repair, remodelling and regeneration capacity

et al. 2020

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Transcatheter mitral valve implantation: supra-annular and subvalvular fixation techniques

Cited by 4 publications

References 21 publications

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Transcatheter Mitral Valve Replacement: A Novel Anchor Technology

Next-generation tissue-engineered heart valves with repair, remodelling and regeneration capacity

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