title: New Self-Expanding Transcatheter Valve for Off-Pump Transatrial Mitral Valve-In-Ring Implantation.
abstract: OBJECTIVE
  To validate a self-expanding transcatheter valve for off-pump transatrial mitral valve-in-ring (VIR) implantation via a left thoracotomy.
  
  
  METHODS
  Mitral valve annuloplasty was performed via sternotomy during cardiopulmonary bypass on 9 pigs. After successful weaning from extracorporal circulation, the custom-made, self-expanding transcatheter VIR device was deployed under fluoroscopic guidance within the annuloplasty ring via a left thoracotomy. Hemodynamic data before and after the implantation were recorded. Mitral annulus diameter and valve area were measured by echocardiography. Transvalvular and left-ventricular outflow-tract pressure gradient were measured invasively.
  
  
  RESULTS
  Eight successful implantations were performed. Implantation failed in 1 pig because of difficulty with technical delivery of the sheath. Mean transatrial procedure time was 12.6 ± 1.7 min. Hemodynamic status during transatrial implantation was stable, and differences were not statistically significant. Mean mitral annulus diameter and mean mitral orifice area were 2.32 ± 0.2 and 3.84 ± 0.55 cm2, respectively. Mild regurgitation was detected in 7 animals and moderate regurgitation in 1. Mean gradients were 6.1 ± 5.0 mm Hg across the device. Postmortem examination confirmed adequate positioning of devices within the annuloplasty ring.
  
  
  CONCLUSIONS
  This custom-made transcatheter device allows for safe and reproducible off-pump transatrial mitral VIR implantations. Transatrial access is a promising route to facilitate VIR implantations. Our custom-made stent-valve may be suitable for VIR procedures.
authors: Department of Cardiac Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China.
authors: Liang
authors: L
authors: Ma
authors: Zipu
authors: Z
authors: Yu
authors: Christoph
authors: C
authors: Huber
authors: Chengchen
authors: C
authors: Li
authors: Linfeng
authors: L
authors: Qian
authors: Jianjie
authors: J
authors: Jiang
authors: Yu
authors: Y
authors: Zou
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000379:methods*; D002315:Cardiopulmonary Bypass; D004452:Echocardiography; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006439:Hemodynamics; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation*; D061646:Operative Time; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015607:Stents; D013552:Swine; D013908:Thoracotomy