Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model
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 prolapse that uses a novel leaflet plication clip to selectively plicate the prolap...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2014-02, Vol.147 (2), p.783-791 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Feins, Eric N., MD Yamauchi, Haruo, MD, PhD Marx, Gerald R., MD Freudenthal, Franz P., MD Liu, Hua, MS del Nido, Pedro J., MD Vasilyev, Nikolay V., MD |
| description | 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 prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip’s efficacy was tested in an animal model. Methods Yorkshire pigs (n = 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 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 |
| doi_str_mv | 10.1016/j.jtcvs.2013.09.044 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3947119</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022522313011410</els_id><sourcerecordid>1490699225</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4294-979b357284129b752f27194452edab2b4dc58a91e73e058fd5f673494a47be7c3</originalsourceid><addsrcrecordid>eNqFkl2L1TAQhoso7tnVXyBILr1pnXz0pLlwQRZ1hQXBD_AupunUTU2bmvRU9t-betZFvRECucj7vjOTZ4riCYWKAt0_H6phsWuqGFBegapAiHvFjoKS5b6pP98vdgCMlTVj_KQ4TWkAAAlUPSxOmGAUGg674st7nI2LJPRkDmnB6EIko1ui8WQ1fkUyx-DNnJD8cMs1MWQKK3ri0fQeFzJ7Z83iwkSsdzNxEzHbcWP2j6FD_6h40Buf8PHtfVZ8ev3q48VlefXuzduLl1elFUyJUknV8lqyRlCmWlmznkmqhKgZdqZlrehs3RhFUXKEuum7ut9LLpQwQrYoLT8rzo-586EdsbM4bTPoOeZW4o0Oxum_XyZ3rb-GVXMlJKUqBzy7DYjh-wHTokeXLHpvJgyHpKlQsFeKsTpL-VFqY0gpYn9XhoLe2OhB_2KjNzYalM5ssuvpnx3eeX7DyIIXRwHmf1odRp2sw8li5yLaRXfB_afA-T_-zGTKfPw3vME0hEOcMgJNdWIa9IdtPbbtoBwoFRT4TzNUtxY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1490699225</pqid></control><display><type>article</type><title>Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Feins, Eric N., MD ; Yamauchi, Haruo, MD, PhD ; Marx, Gerald R., MD ; Freudenthal, Franz P., MD ; Liu, Hua, MS ; del Nido, Pedro J., MD ; Vasilyev, Nikolay V., MD</creator><creatorcontrib>Feins, Eric N., MD ; Yamauchi, Haruo, MD, PhD ; Marx, Gerald R., MD ; Freudenthal, Franz P., MD ; Liu, Hua, MS ; del Nido, Pedro J., MD ; Vasilyev, Nikolay V., MD</creatorcontrib><description>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 prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip’s efficacy was tested in an animal model. Methods Yorkshire pigs (n = 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 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 < .05), and decreased to mild after clip placement (0-3+) ( P < .05). Vena contracta area tended to increase after cutting the chordae and decrease after clip placement: 0.08 ± 0.10 cm2 versus 0.21 ± 0.15 cm2 versus 0.16 ± 0.16 cm2 ( P = .21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51 ± 0.07 cm versus 0.44 ± 0.18 cm ( P = 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.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2013.09.044</identifier><identifier>PMID: 24210830</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Animals ; Cardiac Surgical Procedures - adverse effects ; Cardiac Surgical Procedures - instrumentation ; Cardiopulmonary Bypass ; Cardiothoracic Surgery ; Disease Models, Animal ; Echocardiography, Doppler, Color ; Equipment Design ; Materials Testing ; Mitral Valve - diagnostic imaging ; Mitral Valve - physiopathology ; Mitral Valve - surgery ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - etiology ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - surgery ; Mitral Valve Prolapse - complications ; Mitral Valve Prolapse - diagnostic imaging ; Mitral Valve Prolapse - physiopathology ; Mitral Valve Prolapse - surgery ; Surgical Fixation Devices ; Swine ; Time Factors</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2014-02, Vol.147 (2), p.783-791</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2014 The American Association for Thoracic Surgery</rights><rights>Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><rights>2013 The American Association For Thoracic Surgery. Published by Mosby, Inc. All rights reserved. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4294-979b357284129b752f27194452edab2b4dc58a91e73e058fd5f673494a47be7c3</citedby><cites>FETCH-LOGICAL-c4294-979b357284129b752f27194452edab2b4dc58a91e73e058fd5f673494a47be7c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2013.09.044$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24210830$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feins, Eric N., MD</creatorcontrib><creatorcontrib>Yamauchi, Haruo, MD, PhD</creatorcontrib><creatorcontrib>Marx, Gerald R., MD</creatorcontrib><creatorcontrib>Freudenthal, Franz P., MD</creatorcontrib><creatorcontrib>Liu, Hua, MS</creatorcontrib><creatorcontrib>del Nido, Pedro J., MD</creatorcontrib><creatorcontrib>Vasilyev, Nikolay V., MD</creatorcontrib><title>Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>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 prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip’s efficacy was tested in an animal model. Methods Yorkshire pigs (n = 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 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 < .05), and decreased to mild after clip placement (0-3+) ( P < .05). Vena contracta area tended to increase after cutting the chordae and decrease after clip placement: 0.08 ± 0.10 cm2 versus 0.21 ± 0.15 cm2 versus 0.16 ± 0.16 cm2 ( P = .21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51 ± 0.07 cm versus 0.44 ± 0.18 cm ( P = 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.</description><subject>Animals</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Cardiac Surgical Procedures - instrumentation</subject><subject>Cardiopulmonary Bypass</subject><subject>Cardiothoracic Surgery</subject><subject>Disease Models, Animal</subject><subject>Echocardiography, Doppler, Color</subject><subject>Equipment Design</subject><subject>Materials Testing</subject><subject>Mitral Valve - diagnostic imaging</subject><subject>Mitral Valve - physiopathology</subject><subject>Mitral Valve - surgery</subject><subject>Mitral Valve Insufficiency - diagnostic imaging</subject><subject>Mitral Valve Insufficiency - etiology</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Mitral Valve Prolapse - complications</subject><subject>Mitral Valve Prolapse - diagnostic imaging</subject><subject>Mitral Valve Prolapse - physiopathology</subject><subject>Mitral Valve Prolapse - surgery</subject><subject>Surgical Fixation Devices</subject><subject>Swine</subject><subject>Time Factors</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl2L1TAQhoso7tnVXyBILr1pnXz0pLlwQRZ1hQXBD_AupunUTU2bmvRU9t-betZFvRECucj7vjOTZ4riCYWKAt0_H6phsWuqGFBegapAiHvFjoKS5b6pP98vdgCMlTVj_KQ4TWkAAAlUPSxOmGAUGg674st7nI2LJPRkDmnB6EIko1ui8WQ1fkUyx-DNnJD8cMs1MWQKK3ri0fQeFzJ7Z83iwkSsdzNxEzHbcWP2j6FD_6h40Buf8PHtfVZ8ev3q48VlefXuzduLl1elFUyJUknV8lqyRlCmWlmznkmqhKgZdqZlrehs3RhFUXKEuum7ut9LLpQwQrYoLT8rzo-586EdsbM4bTPoOeZW4o0Oxum_XyZ3rb-GVXMlJKUqBzy7DYjh-wHTokeXLHpvJgyHpKlQsFeKsTpL-VFqY0gpYn9XhoLe2OhB_2KjNzYalM5ssuvpnx3eeX7DyIIXRwHmf1odRp2sw8li5yLaRXfB_afA-T_-zGTKfPw3vME0hEOcMgJNdWIa9IdtPbbtoBwoFRT4TzNUtxY</recordid><startdate>201402</startdate><enddate>201402</enddate><creator>Feins, Eric N., MD</creator><creator>Yamauchi, Haruo, MD, PhD</creator><creator>Marx, Gerald R., MD</creator><creator>Freudenthal, Franz P., MD</creator><creator>Liu, Hua, MS</creator><creator>del Nido, Pedro J., MD</creator><creator>Vasilyev, Nikolay V., MD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201402</creationdate><title>Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model</title><author>Feins, Eric N., MD ; Yamauchi, Haruo, MD, PhD ; Marx, Gerald R., MD ; Freudenthal, Franz P., MD ; Liu, Hua, MS ; del Nido, Pedro J., MD ; Vasilyev, Nikolay V., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4294-979b357284129b752f27194452edab2b4dc58a91e73e058fd5f673494a47be7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Animals</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Cardiac Surgical Procedures - instrumentation</topic><topic>Cardiopulmonary Bypass</topic><topic>Cardiothoracic Surgery</topic><topic>Disease Models, Animal</topic><topic>Echocardiography, Doppler, Color</topic><topic>Equipment Design</topic><topic>Materials Testing</topic><topic>Mitral Valve - diagnostic imaging</topic><topic>Mitral Valve - physiopathology</topic><topic>Mitral Valve - surgery</topic><topic>Mitral Valve Insufficiency - diagnostic imaging</topic><topic>Mitral Valve Insufficiency - etiology</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Mitral Valve Prolapse - complications</topic><topic>Mitral Valve Prolapse - diagnostic imaging</topic><topic>Mitral Valve Prolapse - physiopathology</topic><topic>Mitral Valve Prolapse - surgery</topic><topic>Surgical Fixation Devices</topic><topic>Swine</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feins, Eric N., MD</creatorcontrib><creatorcontrib>Yamauchi, Haruo, MD, PhD</creatorcontrib><creatorcontrib>Marx, Gerald R., MD</creatorcontrib><creatorcontrib>Freudenthal, Franz P., MD</creatorcontrib><creatorcontrib>Liu, Hua, MS</creatorcontrib><creatorcontrib>del Nido, Pedro J., MD</creatorcontrib><creatorcontrib>Vasilyev, Nikolay V., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feins, Eric N., MD</au><au>Yamauchi, Haruo, MD, PhD</au><au>Marx, Gerald R., MD</au><au>Freudenthal, Franz P., MD</au><au>Liu, Hua, MS</au><au>del Nido, Pedro J., MD</au><au>Vasilyev, Nikolay V., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2014-02</date><risdate>2014</risdate><volume>147</volume><issue>2</issue><spage>783</spage><epage>791</epage><pages>783-791</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>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 prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip’s efficacy was tested in an animal model. Methods Yorkshire pigs (n = 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 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 < .05), and decreased to mild after clip placement (0-3+) ( P < .05). Vena contracta area tended to increase after cutting the chordae and decrease after clip placement: 0.08 ± 0.10 cm2 versus 0.21 ± 0.15 cm2 versus 0.16 ± 0.16 cm2 ( P = .21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51 ± 0.07 cm versus 0.44 ± 0.18 cm ( P = 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.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24210830</pmid><doi>10.1016/j.jtcvs.2013.09.044</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Animals Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - instrumentation Cardiopulmonary Bypass Cardiothoracic Surgery Disease Models, Animal Echocardiography, Doppler, Color Equipment Design Materials Testing Mitral Valve - diagnostic imaging Mitral Valve - physiopathology Mitral Valve - surgery Mitral Valve Insufficiency - diagnostic imaging Mitral Valve Insufficiency - etiology Mitral Valve Insufficiency - physiopathology Mitral Valve Insufficiency - surgery Mitral Valve Prolapse - complications Mitral Valve Prolapse - diagnostic imaging Mitral Valve Prolapse - physiopathology Mitral Valve Prolapse - surgery Surgical Fixation Devices Swine Time Factors |
| title | Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model |
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