title: Percutaneous transvenous Melody valve-in-ring procedure for mitral valve replacement.
abstract: OBJECTIVE
  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.
authors: Gorman Cardiovascular Research Group, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors: Takashi
authors: T
authors: Shuto
authors: Norihiro
authors: N
authors: Kondo
authors: Yoav
authors: Y
authors: Dori
authors: Kevin J
authors: KJ
authors: Koomalsingh
authors: Andrew C
authors: AC
authors: Glatz
authors: Jonathan J
authors: JJ
authors: Rome
authors: Joseph H
authors: JH
authors: Gorman
authors: Robert C
authors: RC
authors: Gorman
authors: Matthew J
authors: MJ
authors: Gillespie
mesh_terms: D000800:Angioplasty, Balloon; D000818:Animals; D018618:Echocardiography, Doppler, Color; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000601:surgery; D012756:Sheep