Percutaneous transvenous melody valve-in-ring procedure for mitral valve replacement

Takashi Shuto, Norihiro Kondo, Yoav Dori, Kevin J. Koomalsingh, Andrew C. Glatz, Jonathan J. Rome, Joseph H. Gorman, Robert C. Gorman, Matthew J. Gillespie

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Objectives: The purpose of this study was to demonstrate the feasibility of percutaneous transvenous mitral valve-in-ring (VIR) implantation using the Melody valve in an ovine model. Background: The recurrence of mitral regurgitation following surgical mitral valve (MV) repair in both adult and pediatric patients remains a significant clinical problem. Mitral annuloplasty rings are commonly used in MV repair procedures and may serve as secure landing zones for percutaneous valves. Methods: Five sheep underwent surgical MV annuloplasty (24 mm, n = 2; 26 mm, n = 2; 28 mm, n = 1). Animals underwent cardiac catheterization with VIR implantation via a transfemoral venous, transatrial septal approach 1 week following surgery. Hemodynamic, angiographic, and echocardiographic data were recorded before and after VIR. Results: VIR was technically successful and required <1 h of procedure time in all animals. Fluoroscopy demonstrated securely positioned Melody valves within the annuloplasty ring in all animals. Angiography revealed no significant MV regurgitation in 4 and moderate central MV regurgitation in the animal with the 28-mm annuloplasty. All animals demonstrated vigorous left ventricular function, no outflow tract obstruction, and no aortic valve insufficiency. Conclusions: This study demonstrated the feasibility of a purely percutaneous approach to MV replacement in patients with preexisting annuloplasty rings. This novel approach may be of particular benefit to patients with failed repair of ischemic mitral regurgitation and in pediatric patients with complex structural heart disease.

Original languageEnglish
Pages (from-to)2475-2480
Number of pages6
JournalJournal of the American College of Cardiology
Volume58
Issue number24
DOIs
StatePublished - Dec 6 2011

Keywords

  • Melody valve
  • annuloplasty ring
  • mitral valve
  • mitral valve insufficiency
  • mitral valve repair
  • mitral valve replacement
  • percutaneous valve replacement

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