Interventional Cardiology
Figure 12: i-Coapys Device
Right ventricle Mitral valve
implants were realised in two patients, but the sponsoring company has now gone out of business.
Posterior pad Subvalvular chord Anterior pad Left ventricle
SL annular cinching, remodelling the left ventricular chamber and reducing the functional MR, have been developed.
Coapsys
The Coapsys device (Myocor Inc,
Minneapolis, Minnesota) is
composed of a pair of epicardial pads that are anchored on the LV surface, with a tensioning cable passed through the LV cavity to pull the pads together, thereby reducing the SL dimension of the mitral annulus and diminishing the LV chamber diameter (see Figure 12). This procedure is performed using both open-chest and closed-chest approaches. To date, the majority of the experience is with the surgical approach. Over 150 patients have been treated with this surgical device and reductions in MR have been sustained up to 12 months.71
The i-Coapys device is a percutaneous adaptation of the
surgical device. A transpericardial percutaneous approach has been developed and used successfully in animal models.72,73
Human
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Conclusions
Percutaneous valve therapy of AS and MR represents the biggest innovation in cardiology over the last 30 years, since the introduction of coronary angioplasty. Although these methods are still in their infancy, they have attracted unprecedented interest and enthusiasm among cardiologists and surgeons and in very few years have became a concrete alternative to surgical valve repair or replacement. To date, transcatheter treatment of aortic valve stenosis is in a more advanced phase of experimentation than percutaneous MVR. The presence of a published consensus75
underlines this difference. Moreover, there are
still many issues open, in particular the durability of the currently available devices and, bearing in mind that the surgical option remains the ‘gold standard’ therapy, patient selection. Nowadays, there are two main models that are utilised to evaluate the surgical risk: the Society of Thoracic Surgery Predicted risk for Mortality (STS-PROM)76
and the
European System for Cardiac Operative Risk Evaluation (EuroSCORE).77 Although these two scores represent the sole methods by which to objectively calculate surgical risk, they are burdened with many limitations. Thus, the key element to establish whether patients are at high risk of surgery remains clinical judgement. n
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56. Webb JG, et al., EuroIntervention, 2009;5(1):86–9. 57. Grossi EA, et al., J Thorac Cardiovasc Surg, 2001;122(6):1107–24.
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PS3 System
The percutaneous septal sinus shortening system (PS3 System™, Ample Medical, Inc., Foster City, CA) is a transcatheter device that realises chamber remodelling using anchors in the coronary sinus and foramen ovale. It consists of a percutaneously placed interatrial septal anchor, a coronary sinus anchor and a connecting bridge element. By tensioning the suture, the LV chamber decreases its dimension, resulting in reduction of functional MR. The PS3 System has been shown in pre-clinical studies to acutely and chronically reduce functional MR in an ovine tachycardia model.74
74
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