Background: A longer-arm clip design for transcatheter edge-to-edge repair of mitral and tricuspid valves could be beneficial in treating complex valve pathologies. Its hemodynamic effects and usability are unknown. This study aims to assess its new design in an ex-vivo beating heart model. Methods: The long-arm clip was implanted in porcine left (n = 14) and right (n = 6) hearts with induced degenerative mitral regurgitation and functional tricuspid regurgitation, respectively. Hemodynamic conditions were assessed at baseline, pathology and post-treatment. Usability and grasping quality were evaluated during simulated treatment. Results: Mitral valve treatment significantly increased cardiac output (p < 0.001) and decreased mean left atrial pressure during ventricular systole (p = 0.001) with respect to pathological conditions. Tricuspid treatment with grasping involving septal leaflet significantly increased cardiac output (posterior-septal grasping: p = 0.006; anterior-septal grasping: p = 0.04). There was no significant increase of transvalvular gradient pressure nor tissue damage. Conclusion: Long-arm clip treatment was feasible in porcine hearts, it effectively reduced regurgitation and did not significantly increase the transvalvular pressure gradient.

Long-arm Clip for Transcatheter Edge-to-Edge Treatment of Mitral and Tricuspid Regurgitation – Ex-Vivo Beating Heart Study

Michal Jaworek;Federico Lucherini;Gianfranco beniamino fiore;riccardo Vismara;
2019

Abstract

Background: A longer-arm clip design for transcatheter edge-to-edge repair of mitral and tricuspid valves could be beneficial in treating complex valve pathologies. Its hemodynamic effects and usability are unknown. This study aims to assess its new design in an ex-vivo beating heart model. Methods: The long-arm clip was implanted in porcine left (n = 14) and right (n = 6) hearts with induced degenerative mitral regurgitation and functional tricuspid regurgitation, respectively. Hemodynamic conditions were assessed at baseline, pathology and post-treatment. Usability and grasping quality were evaluated during simulated treatment. Results: Mitral valve treatment significantly increased cardiac output (p < 0.001) and decreased mean left atrial pressure during ventricular systole (p = 0.001) with respect to pathological conditions. Tricuspid treatment with grasping involving septal leaflet significantly increased cardiac output (posterior-septal grasping: p = 0.006; anterior-septal grasping: p = 0.04). There was no significant increase of transvalvular gradient pressure nor tissue damage. Conclusion: Long-arm clip treatment was feasible in porcine hearts, it effectively reduced regurgitation and did not significantly increase the transvalvular pressure gradient.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11311/1121458
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