chapter  38
7 Pages

Percutaneous left ventricular chamber and mitral annular remodeling

WithWes R Pedersen, Peter Block, Ted Feldman

Functional mitral regurgitation (FMR) is a ventricular disease characterized by mitral insufficiency in the absence of structural valve abnormalities. It occurs either in the presence of dilated (non-ischemic) cardiomyopathy or in association with regional (ischemic) left ventricular dysfunction. Medical therapy is of limited benefit and currently treatment falls predominantly in the realm of open heart surgery, including either annuloplasty repair or prosthetic valve replacement. These cardiac surgical techniques suffer significantly from their failure to address the primary underlying problem of ventricular distortion and by virtue of their highly invasive nature. The need for a less invasive and a more integrated approach directed at reshaping the remodeled left ventricle and mitral valve annulus is now recognized. Two novel and related technologies, the surgical Coapsys and the percutaneous iCoapsys devices are currently under investigation. Although the methods for delivering each of these

devices are different, the actual implants are remarkably similar. Both devices consist of anterior and posterior epicardial pads connected by a subvalvular (i.e. transventricular) chord that passes midway between the papillary muscles (Figure 38.1). Sizing instruments are used to reduce the chord length between the two pads, resulting in septal-lateral reduction of the left ventricular and annular dimensions, thereby compressing the regurgitant orifice and reducing MR. No adverse consequences on ventricular systolic or diastolic function have been demonstrated in patients treated thus far with the surgical Coapsys system.1-4

The Coapsys (surgical) device is delivered using an open chest approach through a median sternotomy. It is implanted on a beating heart in the absence of cardiopulmonary bypass or atriotomy using direct visualization of external landmarks and epicardial two-dimensional (2D) echocardiography of relevant internal structures.1