Changes in mitral annular and left ventricular dimensions and left ventricular pressure–volume relations after off-pump treatment of mitral regurgitation with the Coapsys device

Fukamachi, Kiyotaka; Popović, Zoran B.; Inoue, Masahiro; Doi, Kazuyoshi; Schenk, Soren; Ootaki, Yoshio; Kopcak Jr., Michael W.; McCarthy, Patrick M.
March 2004
European Journal of Cardio-Thoracic Surgery;Mar2004, Vol. 25 Issue 3, p352
Academic Journal
Objective: The objective of this study was to evaluate the changes in mitral annular and left ventricular dimensions and left ventricular pressure–volume relations produced by the Myocor Coapsys device that has been developed to treat functional mitral regurgitation (MR) off-pump. Methods: The Coapsys device, which consists of anterior and posterior epicardial pads connected by a sub-valvular chord, was implanted in seven dogs with functional MR resulting from pacing induced cardiomyopathy. The Coapsys device was then sized by drawing the posterior leaflet and annulus toward the anterior leaflet. During sizing, MR grade was assessed using color flow Doppler echocardiography. Final device size was selected when MR was eliminated or minimized. Following implantation, heart failure was maintained by continued pacing for a period of 8 weeks. Mitral annular and left ventricular dimensions and left ventricular pressure–volume relations were evaluated by two-dimensional echocardiography and a conductance catheter, respectively, at pre-sizing, post-sizing, and after 8 weeks. Results: All implants were performed on beating hearts without cardiopulmonary bypass. Mean MR grade was reduced from 2.9±0.7 at pre-sizing to 0.7±0.8 at post-sizing (P<0.001), and was maintained at 0.8±0.8 after 8 weeks (P<0.01). The septal–lateral dimensions were significantly reduced at both mitral annular level [2.4±0.2 cm at pre-sizing, 1.5±0.3 cm at post-sizing (P<0.001), and 1.8±0.3 cm after 8 weeks (P<0.05)] and mid-papillary level [4.1±0.4 cm at pre-sizing, 2.4±0.2 cm at post-sizing (P<0.001), and 3.3±0.4 cm after 8 weeks (P<0.001)]. The end-systolic pressure–volume relation shifted leftward at post-sizing with a significantly steeper slope (P=0.03). There was a significant (P=0.03) leftward shift of the end-diastolic pressure–volume relation at post-sizing. After 8 weeks, these changes in pressure–volume relations tended to return to pre-sizing relations. Conclusions: The Coapsys device significantly reduced MR by treating both the mitral annular dilatation and the papillary muscle displacement. Despite these significant dimensional changes, the Coapsys device did not negatively affect the left ventricular pressure–volume relations.


Related Articles

  • Combined Computational and Experimental Approach to Improve the Assessment of Mitral Regurgitation by Echocardiography. Sonntag, Simon; Li, Wei; Becker, Michael; Kaestner, Wiebke; Büsen, Martin; Marx, Nikolaus; Merhof, Dorit; Steinseifer, Ulrich // Annals of Biomedical Engineering;May2014, Vol. 42 Issue 5, p971 

    Mitral regurgitation (MR) is one of the most frequent valvular heart diseases. To assess MR severity, color Doppler imaging (CDI) is the clinical standard. However, inadequate reliability, poor reproducibility and heavy user-dependence are known limitations. A novel approach combining...

  • Off-pump transapical mitral valve-in-ring implantation. Zou, Yu; Ferrari, Enrico; von Segesser, Ludwig K. // European Journal of Cardio-Thoracic Surgery;Apr2013, Vol. 43 Issue 4, p849 

    OBJECTIVES The study aimed to evaluate the feasibility of off-pump transapical mitral valve-in-ring implantation and to test the performance of a custom-made self-expandable stent valve, in comparison with the standard SAPIEN valve. METHODS Acute experiments were performed in five pigs. Animals...

  • 153 Tissue Doppler imaging (TDI) for estimation of filling pressures validation in patients with primary or secondary mitral regurgitation. Bruch, C.; Stypmann, J.; Grude, M.; Wichter, T. H.; Breithardt, G. // European Journal of Echocardiography;2003, Vol. 4 Issue suppl_1, pS11 

    An abstract of the article "Tissue Doppler imaging (TDI) for estimation of filling pressures validation in patients with primary or secondary mitral regurgitation," by C. Bruch, J. Stypmann, M. Grude, T.H. Wichter, and G. Breithardt is presented.

  • Intraoperative Evaluation of Valvular Function Using Transesophageal and Epicardial Echocardiography. Suenaga, Yoshito; Io, Akinori; Tajima, Kazuyoshi; Min-Ho Song; Shimomura, Takeru // Vascular Surgery;Jan/Feb1995, Vol. 29 Issue 1, p1 

    Objectives and Background. Intraoperative transesophageal echocardiography (TEE) and epicardial echocardiography (ECE) offer the opportunity to assess valvular function before and after cardiopulmonary bypass. Valve reconstruction offers many advantages over prosthetic valve replacement. The...

  • Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Ionescu A; Fraser A G; Butchart E G // Heart;Nov2003, Vol. 89 Issue 11, p1316 

    OBJECTIVE: To assess the prevalence, mechanisms, and significance of paraprosthetic regurgitation detected incidentally by transoesophageal echocardiography (TOE) in patients after heart valve replacement. DESIGN: Prospective observational study. SETTING: Tertiary referral centre. PATIENTS: 360...

  • Docs eye expanded indications for MitraClip in letter to CMS. McCARTY, MARK // Medical Device Daily;11/20/2013, Vol. 17 Issue 225, p1 

    The article reports that after the approval of the MitraClip mitral valve repair device by the U.S. Food and Drug Administration (FDA), a group of four medical societies has recommended coverage of the device for high risk and inoperable patients with moderate to severe mitral valve...

  • Twisting loop technique for anterior mitral cords shortening and evolution. Moriones, I.; Fernandez, J. L.; Sanchez, R.; Jimenez, L.; Sadaba, R.; Gomez, F. // Journal of Cardiothoracic Surgery;2013, Vol. 8 Issue Suppl 1, p1 

    An abstract of the article "Twisting loop technique for anterior mitral cords shortening and evolution" by I. Moriones, J. L. Fernandez, R. Sanchez, L. Jimenez, R. Sadaba and F. Gomez is presented.

  • Detection and significance of subclinical mitral regurgitation by colour Doppler techniques Davies, C.; Sahn, D. // Heart;Apr2001, Vol. 85 Issue 4, p369 

    The authors reflect on the role and importance of colour Doppler techniques in the diagnosis of subclinical mitral regurgitation. The authors cite the study of Levine and colleagues that shows mitral regurgitation as a dynamic entity occuring in earle and late systole with mid-systolic dip. They...

  • Post-mitral valve repair systolic anterior motion produced by non-obstructive septal bulge Civelek, Ali; Szalay, Zoltan; Roth, Matthias; Arnold, Roman; Klövekorn, Wolf-Peter; Vogt, Paul R.; Bauer, Erwin P. // European Journal of Cardio-Thoracic Surgery;Dec2003, Vol. 24 Issue 6, p857 

    Objective: Systolic anterior motion (SAM) may rarely occur after mitral valve reconstruction due to different anatomic factors. Several techniques have been described to reduce the incidence of post-repair SAM, e.g. leaflet sliding plasty. However, SAM can still occur after these special...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics