Abstract:

Mitral valve (MV) insufficiency is the second most common heart valve disease represented in cardiac surgery. The gold standard therapy is surgical repair of the valve. Today, most centers prefer a minimally invasive approach through a right-sided mini-thoracotomy. Despite the small access, there is still the need to use cardiopulmonary bypass (CPB), and the operation has to be performed on the arrested heart. New devices have been developed to optimize the results of surgical repair by implementing mechanisms for post-implantation adjustment on the beating heart or the avoidance of CPB. Early attempts with adjustable mitral annuloplasty rings go back to the early 1990s. Only a few devices are available on the market. Recently, a mitral valve adjustable annuloplasty ring was CE-marked and is under further clinical investigation. In addition, a sutureless annuloplasty band to be implanted on the beating heart is under preclinical and initial clinical investigation for transatrial and transfemoral transcatheter implantation. Furthermore, new neochord systems are being developed, which allow for functional length adjustment on the beating heart after implantation. Some devices were developed for percutaneous MV repair implanted into the coronary sinus to reshape the posterior MV annulus. Other percutaneous devices are directly fixed to the posterior annulus to alter its shape. Several disadvantages have been observed preventing a broad clinical use of some of these devices. There is a continuous effort to develop innovative techniques to optimize MV repair and to decrease invasiveness.

Authors:

Simon H. Sündermann, MD Resident, Division of Cardiovascular Surgery University Hospital Zurich, Zurich, Switzerland, Jöerg Seeburger, MD, Consultant, Heart Center, University of Leipzig, Clinic for Cardiac SurgeryLeipzig, Germany, Jacques Scherman, MD, Consultant, Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland, Friedrich Wilhelm Mohr, MD, PhD, Chief of Clinic, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Volkmar Falk, MD, PhD, Chief of Division, Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland

PMID: 23315719

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