Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model

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• 作者：Eric N. Feins ; Haruo Yamauchi ; Gerald R. Marx ; Franz P. Freudenthal ; Hua Liu ; Pedro J. del Nido ; Nikolay V. Vasilyev
• 关键词：28 ; 35.4.1
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：February, 2014
• 年：2014
• 卷：147
• 期：2
• 页码：783-791
• 全文大小：1309 K

文摘

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Objective

Recently, there has been increased interest in minimally invasive mitral valve prolapse repair techniques; however, these techniques have limitations. A new technique was developed for treating mitral valve聽prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The聽clip鈥檚 efficacy was tested in an animal model.

Methods

Yorkshire pigs (n聽=聽7) were placed on cardiopulmonary bypass (CPB), and mitral valve prolapse was created by cutting chordae supporting the P2 segment of the posterior leaflet. Animals were weaned off CPB and mitral regurgitation (MR) was assessed echocardiographically. CPB was reinitiated and the plication clip was聽applied under direct vision to the P2 segment to eliminate the prolapse. The animals survived for 2 hours. Epicardial echocardiography was obtained before and after prolapse creation and 2 hours after clip placement to quantify MR grade and vena contracta area. Posterior leaflet mobility and coaptation height were analyzed before and after clip placement.

Results

There were no cases of clip embolization. Median MR grade increased from trivial (0-1.5) to moderate-severe after MR creation (2.5-4+) (P聽<聽.05), and decreased to mild after clip placement (0-3+) (P聽<聽.05). Vena contracta area tended to increase after cutting the chordae and decrease after clip placement: 0.08 卤 0.10 cm² versus 0.21 卤 0.15 cm² versus 0.16 卤 0.16 cm² (P聽=聽.21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51 卤 0.07 cm versus 0.44 卤 0.18 cm (P聽=聽1.0).

Conclusions

The leaflet plication clip can treat mitral valve prolapse in an animal model, restoring coaptation height without affecting leaflet mobility. This approach is a simple technique that may improve the effectiveness of beating-heart and minimally invasive valve surgery.