title: Novel mitral repair device for the treatment of severe mitral regurgitation: preclinical ovine acute and chronic implantation model.
abstract: OBJECTIVE
  A project is now underway to implement a novel percutaneous mitral repair system for severe mitral regurgitation (MR). The initial phase of the project consists of proof-of-concept by testing device characteristics using open surgical implantation. When surgical proof-of-concept of the intended percutaneous design is completed, a second phase of the project will consist of in vivo testing of the percutaneous transseptal system. The device is currently being designed to fold into a 17F catheter system and to unfold within the left atrium where attachment is accomplished using a reversible anchoring system. The purpose of this study was to show functionality of the device in elimination of MR using the open surgical method.
  
  
  METHODS
  We have performed surgical prototype device implantation in 5 acute and 7 chronic sheep preparations. We created a P2-flail model of severe (4+) MR in the 12 sheep. Via a minimally invasive left thoracotomy incision and open repair on cardiopulmonary bypass, the device was implanted to determine efficacy of elimination of severe MR. Implantation was considered successful if 4+ regurgitation was converted to 1+ MR or lower. Left ventriculography and epicardial 2-dimensional/3-dimensional echocardiography were used to assess repair; serial 2-dimensional/3-dimensional transthoracic echocardiography was used to assess long-term mitral repair status.
  
  
  RESULTS
  Twelve sheep had surgical creation of severe (4+) MR by cutting all chordae to the P2 scallop of the mitral valve; this preparation was tested and was found to produce 100% acute fatality without repair of the mitral valve. Five sheep had acute implantation of the device with elimination of regurgitation in 5/5 sheep. Seven sheep had chronic (1-7 month) implantation of the device. The device was tested in the chronic model for clinical status, residual regurgitation, thrombosis, and histopathology. All sheep had mitigation of MR and survived to the intended date of death.
  
  
  CONCLUSIONS
  Proof-of-concept of a novel percutaneous mitral repair device has been completed using an ovine P2-flail severe MR model. The device has characteristics that will allow its use in posterior leaflet degenerative disease and functional/secondary MR. Open, minimally invasive, and robotic surgical implantation of the device can also be developed as an alternative to the percutaneous approach.
authors.affiliation: From the *Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco; and †Middle Peak Medical, Palo Alto, CA USA.
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Hill
authors.forename: Michael D
authors.initials: MD
authors.lastname: Lesh
authors.forename: Alexander
authors.initials: A
authors.lastname: Khairkhahan
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012756:Sheep; D053441:Suture Anchors; D013536:Suture Techniques