Abstract
BackgroundTranscatheter mitral valve replacement (TMVR) is a challenging, but promising minimally invasive treatment option for patients with mitral valve disease. Depending on the anchoring mechanism, complications such as mitral leaflet or chordal disruption, aortic valve disruption or left ventricular outflow tract obstruction may occur. Supra-annular devices only anchor at the left atrial (LA) level with a low risk of these complications. For development of transcatheter valves based on LA anchoring, animal feasibility studies are required. In this study we sought to describe LA systolic and diastolic geometry in an ovine ischemic mitral regurgitation (IMR) model using magnetic resonance imaging (MRI) and echocardiography in order to facilitate future research focusing on TMVR device development for (I)MR with LA anchoring mechanisms.MethodsA group of 10 adult male Dorsett sheep underwent a left lateral thoracotomy. Posterolateral myocardial infarction was created by ligation of the left circumflex coronary artery, the obtuse marginal and diagonal branches. MRI and echocardiography were performed at baseline and 8 weeks after myocardial infarction (MI).ResultsSix animals survived to 8 weeks follow-up. All animals had grade 2 + or higher IMR 8 weeks post-MI. All LA geometric parameters did not change significantly 8 weeks post-MI compared to baseline. Diastolic and systolic interpapillary muscle distance increased significantly 8 weeks post-MI.ConclusionsSystolic and diastolic LA geometry do not change significantly in the presence of grade 2 + or higher IMR 8 weeks post-MI. These findings help facilitate future tailored TMVR device development with LA anchoring mechanisms.
Highlights
Transcatheter mitral valve replacement (TMVR) is a challenging, but promising minimally invasive treatment option for patients with mitral valve disease
Geometric magnetic resonance imaging (MRI) data Ten animals were included in this study at baseline, 6 animals were alive 8 weeks post-myocardial infarction (MI) and underwent followup MRI
Grade 2+ or more ischemic mitral regurgitation (IMR) was observed after 8 weeks in all cases
Summary
Transcatheter mitral valve replacement (TMVR) is a challenging, but promising minimally invasive treatment option for patients with mitral valve disease. Transcatheter mitral valve replacement (TMVR) and repair (TMVr) are enticing, but slowly evolving therapeutic options for patients with MV disease, in particular for those with a high surgical risk and those not eligible for an open procedure. Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe aortic stenosis, the experience with TMVR remains limited [4]. Potential complications of TMVR are LVOT obstruction, device embolization, left ventricular dysfunction (e.g. chordae tendineae rupture) and death [11]. Despite these technical, anatomical, and functional constraints, substantial progress has been made over the last several years. Left atrial anchoring strategies have been proposed, but less well explored
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