Abstract
Background Transcatheter aortic valves have benefitted from device miniaturization and in-situ assembly to reduce delivery system caliber and enable trans-vascular delivery. In contrast, investigational transcatheter mitral prostheses are bulky devices that require large caliber access ports. Trans-apical delivery is undesirable because of increased morbidity associated with rib spreading, closure site bleeding and impact on left ventricle (LV) function. Trans-septal delivery is challenging because of the acute angle required to reach the mitral valve. A ‘straight shot’ to the mitral valve (Fig 1A) that does not violate the LV myocardium is preferable, both in terms of device engineering and patient outcome. We hypothesized that with realtime MR guidance and by deflating a lung, it is possible to access the left atrium (LA) directly through the posterior chest wall, and close the access port using off-the-shelf nitinol devices.
Highlights
Transcatheter aortic valves have benefitted from device miniaturization and in-situ assembly to reduce delivery system caliber and enable trans-vascular delivery
A stiff wire was introduced to the left ventricle (LV) apex, over which an 18Fr sheath with a passive MR marker at the tip was advanced into the left atrium (LA)
Realtime MR guided LA access was successful in all. 3D and cine MRI confirmed that the 18Fr sheath trajectory relative to the plane of the mitral valve was favorable to perform a mitral intervention (Fig 1F)
Summary
Transcatheter aortic valves have benefitted from device miniaturization and in-situ assembly to reduce delivery system caliber and enable trans-vascular delivery. Investigational transcatheter mitral prostheses are bulky devices that require large caliber access ports. Trans-apical delivery is undesirable because of increased morbidity associated with rib spreading, closure site bleeding and impact on left ventricle (LV) function. Trans-septal delivery is challenging because of the acute angle required to reach the mitral valve. A ‘straight shot’ to the mitral valve (Fig 1A) that does not violate the LV myocardium is preferable, both in terms of device engineering and patient outcome. We hypothesized that with realtime MR guidance and by deflating a lung, it is possible to access the left atrium (LA) directly through the posterior chest wall, and close the access port using off-the-shelf nitinol devices
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