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Original Articles

Percutaneous Transvenous Mitral Annuloplasty

Initial Human Experience With a Novel Coronary Sinus Implant Device

Stefan Sack, MD; Philipp Kahlert, MD; Luc Bilodeau, MD; Luc A. Pièrard, MD; Patrizio Lancellotti, MD; Victor Legrand, MD; Jozef Bartunek, MD, PhD; Marc Vanderheyden, MD; Rainer Hoffmann, MD; Patrick Schauerte, MD; Takahiro Shiota, MD; David S. Marks, MD; Raimund Erbel, MD and Stephen G. Ellis, MD

From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and Department of Cardiovascular Medicine (S.E., T.S.), Cleveland Clinic, Cleveland, Ohio.

Correspondence to Stefan Sack, MD, Klinikum Schwabing, Städtisches Klinikum München GmbH, Kölner Platz 1, D-80804 München, Germany. E-mail stefan.sack{at}klinikum-muenchen.de

Received June 26, 2008; accepted April 20, 2009.

Background— We assessed the safety and feasibility of permanent implantation of a novel coronary sinus mitral repair device (PTMA, Viacor Inc).

Methods and Results— Symptomatic (New York Heart Association class 2 or 3) patients with primarily functional mitral regurgitation (MR) were included. A diagnostic PTMA procedure was performed in the coronary sinus venous continuity. MR was assessed and the PTMA device adjusted to optimize efficacy. If MR reduction (1 grade) was observed, placement of a PTMA implant was attempted. Implanted patients were evaluated with echocardiographic, quality of life, and exercise capacity metrics. Nineteen patients received a diagnostic PTMA study. Diagnostic PTMA was effective in 13 patients (MR grade 3.2±0.6 reduced to 2.0±1.0), and PTMA implants were placed in 9 patients. Four devices were removed uneventfully (7, 84, 197, and 216 days), 3 for annuloplasty surgery due to observed PTMA device migration and/or diminished efficacy. No procedure or device-related major adverse events with permanent sequela were observed in any of the diagnostic or implant patients. Sustained reductions of mitral annulus septal-lateral dimension from 3D echo reconstruction dimensions were observed (4.0±1.2 mm at 3 months).

Conclusions— Percutaneous implantation of the PTMA device is feasible and safe. Acute results demonstrate a possibly meaningful reduction of MR in responding patients. Sustained favorable geometric modification of the mitral annulus has been observed, though reduction of MR has been limited. The PTMA method warrants continued evaluation and development.

Key Words: annuloplasty • coronary sinus • heart failure • mitral valve • regurgitation

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