title: New Mitral Annuloplasty Ring Enables Oversizing of Transcatheter Heart Valve and Prevents Central or Paravalvular Leakage.
abstract: BackgroundTranscatheter valve-in-ring strategies have been developed to treat recurrent mitral regurgitation (MR) after failing surgical annuloplasty. However, suboptimal THV expansion with consecutive paravalvular leakage (PVL) is a procedure-immanent issue.MethodsA rigid, saddle-shaped ring was cut at four locations. The segments were reconnected with pull-springs, rearranged to the original shape, and covered with a sewing cuff. The length of the annuloplasty ring construct, including extended pull-springs, was defined by the perimeter of an appropriate THV. We deployed a Sapien XT within the new ring, expanded it to its maximum extent, and investigated the geometrical changes.ResultsFluoroscopy confirmed oval, saddle-shaped ring before dilation. After THV implantation, the ring segments spread apart and pull-springs were stretched. The extended ring changed its configuration from "oval" to "round" and anchored the THV leaving no paravalvular or central gaps as potential source for PVL.ConclusionWe developed an expandable annuloplasty ring that is perfectly concerted to THV implantation. This proof-of-concept study revealed no PVL and good oversizing ability that might impact future annuloplasty ring design. Further studies have to evaluate durability and device safety.
authors.affiliation: Department of Cardiac Surgery, University Heart Center Bonn, Bonn, Nordrhein-Westfalen, Germany.
authors.forename: Georg Daniel
authors.initials: GD
authors.lastname: Duerr
authors.affiliation: Department of Medicine II-Cardiology, University Heart Center Bonn, Bonn, Nordrhein-Westfalen, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Department of Cardiac Surgery, University Heart Center Bonn, Bonn, Nordrhein-Westfalen, Germany.
authors.forename: Armin Georg
authors.initials: AG
authors.lastname: Welz
authors.affiliation: Department of Cardiac Surgery, University Heart Center Bonn, Bonn, Nordrhein-Westfalen, Germany.
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D016896:Treatment Outcome