Robert R. Steckel

Novel suture device for beating-heart mitral leaflet approximation.

BACKGROUND This investigation evaluates the potential of using a novel suturing device to achieve mitral valve repair (Alfieri type) on a beating heart without cardiopulmonary bypass. METHODS Eight healthy adult sheep were anesthetized and the chest was opened via a left thoracotomy. The suture device was directly inserted into the appendage of the left atrium. Suction ports on the distal tip of the device grasped and approximated the mitral leaflets while the heart was beating. Two-dimensional echocardiography and intracardiac pressure monitoring at the tip of the device were utilized to guide the procedure. The device was used to place two single sutures across the two leaflets at the center of the mitral valve. A knot pusher with integrated cutter was used to tie the sutures and cut the suture ends. RESULTS In all animals, the free margins of the mitral leaflets were successfully grasped and approximated by this device. Echocardiography confirmed successful deployment of the sutures in all cases, with a figure-of-eight appearance of the valve and normal valve hemodynamic function after placement of the sutures. Mid-leaflet approximation was verified at autopsy immediately after the procedure. No tissue damage was observed. CONCLUSIONS This study demonstrates that mitral valve repair (Alfieri type) can be performed safely and consistently on a beating heart without cardiopulmonary bypass using this new tissue approximation suture device. This technique may be applicable to the treatment of ischemic mitral regurgitation in conjunction with revascularization procedures or to mitral regurgitation in heart failure patients.

Minimally invasive mitral valve repair

The present invention is directed to an apparatus and method for the stabilization and fastening of two pieces of tissue. A single device may be used to both stabilize and fasten the two pieces of tissue, or a separate stabilizing device may be used in conjunction with a fastening device. The stabilizing device may comprise a probe with vacuum ports and/or mechanical clamps disposed at the distal end to approximate the two pieces of tissue. After the pieces of tissue are stabilized, they are fastened together using sutures or clips. One exemplary embodiment of a suture-based fastener comprises a toggle and suture arrangement deployed by a needle, wherein the needle enters the front side of the tissue and exits the blind side. In a second exemplary embodiment, the suture-based fastener comprises a needle connected to a suture. The needle enters the blind side of the tissue and exits the front side. The suture is then tied in a knot to secure the pieces of tissue. One example of a clip-based fastener comprises a spring-loaded clip having two arms with tapered distal ends and barbs. The probe includes a deployment mechanism which causes the clip to pierce and lockingly secure the two pieces of tissue.Purpose of review Meanwhile mitral valve insufficiency is probably the second most common heart valve disease represented in cardiac surgery. Due to low perioperative morbidity and mortality, nowadays mitral valve repair can even be considered in asymptomatic patients. The enhancements of minimally invasive surgical techniques led to a decrease in surgical trauma and accelerated postoperative recovery, resulting in increased acceptance of these operating techniques. Therefore, the present review focuses on the different surgical access ways to the mitral valve and their significance for mitral valve repair. Recent findings The emergence of transcatheter approaches to mitral valve repair has focused attention on outcomes after surgical mitral valve repair. Results from the EVEREST II trial demonstrated worse short-term major adverse event rates for surgical repair. Recently, several studies were published analyzing contemporary outcomes, morbidity, mortality, and quality of life after conventional and minimally invasive surgical mitral valve repair to establish benchmarks for future therapeutic comparisons. Summary Today mitral valve repair is the gold standard for treatment of significant mitral valve regurgitation with low perioperative morbidity and mortality and excellent long-term results. It can be performed through minimally invasive surgical techniques without compromising long-term durability of repair results, but with a decrease in surgical trauma and accelerated postoperative recovery. Currently, endovascular therapy for mitral regurgitation (e.g., the MitraClip procedure) should be limited to patients who otherwise would not be eligible for surgery.