Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case.

We report the first-in-human mitral valve repair using percutaneous technology that creates a "surgical-like" edge-to-edge repair. A catheter-delivered clip was introduced transseptally from the femoral vein, advanced through the mitral orifice, retracted to grasp the leaflets, and detached to create a functional double-orifice valve. The patient had an uncomplicated post-procedural course.

Percutaneous aortic valve replacement and mitral valve repair.

For mitral regurgitation and aortic valve disease warranting replacement, the surgical approach has been the mainstay therapy since the 1960s. Technological advances have provided potentially less invasive alternatives to surgery. Novel catheter-based techniques include aortic valve replacement with a valved stent, and devices aimed at reconfiguring the annulus or approximating a portion of the leaflets for mitral regurgitation.

Beating heart catheter-based edge-to-edge mitral valve procedure in a porcine model: efficacy and healing response.

Background: Surgical edge-to-edge repair has been used in the treatment of mitral regurgitation. We evaluated the ability of a catheter-delivered clip (Evalve, Inc) to achieve edge-to-edge mitral valve approximation without cardiopulmonary bypass and the healing response of this technique.

Methods And Results: Twenty-one pigs underwent general anesthesia and left thoracotomy.

Endovascular edge-to-edge mitral valve repair: short-term results in a porcine model.

Background: The edge-to-edge technique is an accepted method for the surgical repair of a regurgitant mitral valve. This study reports the initial use of an endovascular technology that enables a double-orifice edge-to-edge mitral valve repair without cardiopulmonary bypass in an animal model.

Methods And Results: Adult pigs (n=14) were anesthetized, and left thoracotomy was performed for epicardial echo imaging.

Renal artery stenosis and ischemic nephropathy.

Renal artery stenosis (RAS), in its most severe form, can result in diminished renal function and loss of kidney mass. The prevalence of ischemic nephropathy is greatly under-appreciated in the elderly population and is the source of substantial morbidity and mortality. Diagnostic tests for RAS in patients with renal insufficiency are problematic, and medical therapy does little to slow the natural progression of the disease.

Percutaneous arterial aortoiliac intervention.

Historically reconstructive vascular surgery, has been a cornerstone of treatment for symptomatic obliterative aortoiliac disease. Surgical results include a reported aortobifemoral bypass 5-year patency rate from 85% to 90% and a 10-year patency rate of 70% to 75%. Operative mortality for aortoiliac reconstruction ranges from 1.

Analysis of the relation between stent implantation pressure and expansion. Optimal Stent Implantation (OSTI) Investigators.

Palmaz-Schatz stents were implanted in 79 lesions in 76 patients, and serially expanded at 12, 15, and 18 atm of pressure using noncompliant balloons. By core lab analysis, intravascular ultrasound demonstrated marked stent expansion as pressure was raised, which was not apparent by angiography.

Bilateral aortoostial coronary artery disease: moyamoya of the heart?

Moyamoya is a vascular occlusive disease typically limited to the cerebral arterial system. We report a case of severe stenosis of the left main and right coronary arteries occurring in association with moyamoya disease, supporting the concept that moyamoya may be an intracranial manifestation of a systemic arterial disorder.

Clinical and angiographic follow-Up after primary stenting in acute myocardial infarction: the Primary Angioplasty in Myocardial Infarction (PAMI) stent pilot trial.

Background: Restenosis has been reported in as many as 50% of patients within 6 months after PTCA in acute myocardial infarction (AMI), which necessitates repeat target-vessel revascularization (TVR) in approximately 20% of patients during this time period. Routine (primary) stent implantation after PTCA has the potential to further improve late outcomes.

Methods And Results: Primary stenting was performed as part of a prospective study in 236 consecutive patients without contraindications who presented with AMI of <12 hours' duration at 9 international centers.

Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: in-hospital and 30-day results of the PAMI stent pilot trial. Primary Angioplasty in Myocardial Infarction Stent Pilot Trial Investigators.

Objectives: The goals of this study were to examine the safety and feasibility of a routine (primary) stent strategy in acute myocardial infarction (AMI).

Background: Limitations of reperfusion by primary percutaneous transluminal coronary angioplasty (PTCA) in AMI include in-hospital recurrent ischemia or reinfarction in 10% to 15% of patients, restenosis in 37% to 49% and late infarct-related artery reocclusion in 9% to 14%. By lowering the residual stenosis and sealing dissection planes created by PTCA, primary stenting may further improve short- and long-term outcomes after mechanical reperfusion.

Minimally invasive mitral valve surgery.

Because of advances in video-assisted general and thoracic surgery, minimally invasive cardiac surgery has been successfully performed experimentally and clinically. Recently described techniques of less invasive mitral valve surgery include limited right thoracotomy, parasternal incision, and partial sternotomy. These methods have been coupled to video-assisted thoracoscopy to further decrease the incision size.

Monitoring considerations for port-access cardiac surgery.

Background: A method for monitoring patients was evaluated in a clinical trial of minimally invasive port-access cardiac surgery with closed chest endovascular cardiopulmonary bypass.

Methods And Results: Cardiopulmonary bypass was conducted in 25 patients through femoral cannulas. An endovascular pulmonary artery vent was placed in the main pulmonary artery through a jugular vein.

Closed-chest cardiopulmonary bypass and cardioplegia: basis for less invasive cardiac surgery.

Background: We developed a method of closed-chest cardiopulmonary bypass to arrest and protect the heart with cardioplegic solution. This method was used in 54 dogs and the results were retrospectively analyzed.

Methods: Bypass cannulas were placed in the right femoral vessels.

Port-access cardiac operations with cardioplegic arrest.

Background: A less invasive approach to cardiac surgery has been propelled by recent advances in video-assisted surgery. Previous obstacles to minimally invasive cardiac operations with cardioplegic arrest included limitations in operative exposure, inadequate perfusion technology, and inability to provide myocardial protection.

Methods: Port-access technology allows endovascular aortic occlusion, cardioplegia delivery, and left ventricular decompression.

Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing: the CLOUT Pilot Trial. Clinical Outcomes With Ultrasound Trial (CLOUT) Investigators.

Background: Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion (the Glagov phenomenon) at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound (IVUS) guidance.

Methods And Results: After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane.

Port-access cardiac surgery with cardiopulmonary bypass and cardioplegic arrest.

In the past decade, laparoscopic and thoracoscopiC technology have significantly and irreversibly altered the approach to many general and thoracic surgical diseases. With advances in laparoscopy and thoracoscopy, the concept of a minimally invasive approach to cardiac surgery has been realized.

Port-access bilateral internal mammary artery grafting for left main coronary artery disease: canine feasibility study.

Background: To extend the applications of minimal access cardiac surgery, an endovascular cardiopulmonary bypass (CPB) system that allows cardioplegia delivery and cardiac venting was used to perform bilateral internal mammary artery (IMA) bypass grafting in six dogs.

Methods: The left IMA (LIMA) was taken down thoracoscopically from three left lateral chest ports, followed by the right IMA (RIMA) from the right side. One left-sided port was extended medially 5 cm with or without rib resection, to expose the pericardium.

Port-access coronary artery bypass with cardioplegic arrest: acute and chronic canine studies.

Background: Our goal is to perform minimally invasive coronary artery bypass grafting without sacrificing the benefits of myocardial protection with cardioplegia.

Methods: Twenty-three dogs underwent acute studies and 4 dogs underwent survival studies. The left internal mammary artery was taken down using a thoracoscope.

Initial clinical experience with a novel low-profile integrated ultrasound-angioplasty catheter.

This report is the first clinical description of the use of a new low-profile integrated ultrasound-angioplasty catheter (the Oracle Micro, Endosonics Corp.), which has recently been approved by the FDA for routine use during percutaneous transluminal coronary angioplasty (PTCA). PTCA was performed in 44 patients at two clinical sites.

Spontaneous coronary dissection resulting in acute myocardial infarction: successful treatment with primary angioplasty.

Spontaneous coronary dissection is an unusual cause of acute myocardial infarction for which the optimal therapy has not been established. We report the case of a 63-year-old man with acute lateral wall myocardial infarction resulting from spontaneous dissection of the major diagonal branch of the left anterior descending artery in whom acute and long-term patency was restored by primary PTCA.

Port-access coronary artery bypass grafting: a proposed surgical method.

Minimally invasive surgical methods have been developed to provide patients the benefits of open operations with decreased pain and suffering. We have developed a system that allows the performance of cardiopulmonary bypass and myocardial protection with cardioplegic arrest without sternotomy or thoracotomy. In a canine model, we successfully used this system to anastomose the internal thoracic artery to the left anterior descending coronary artery in nine of 10 animals.

Minimally invasive cardiopulmonary bypass with cardioplegic arrest: a closed chest technique with equivalent myocardial protection.

Thoracoscopic cardiac surgery is presently under intense investigation. This study examined the feasibility and efficacy of closed chest cardiopulmonary bypass and cardioplegic arrest in comparison with standard open chest methods in a dog model. The minimally invasive closed chest group (n = 6) underwent percutaneous cardiopulmonary bypass and cardiac venting, as well as antegrade cardioplegic arrest through use of a specially designed percutaneous endovascular aortic occluder and cardioplegic solution delivery system.

Feasibility of serial intracoronary ultrasound imaging for assessment of progression of intimal proliferation in cardiac transplant recipients.

Background: Serial quantitative coronary angiography is used to assess progression of coronary disease; however, pathology studies have demonstrated angiographic insensitivity for determining atheroma. Intracoronary ultrasound (ICUS) can define and measure the components of the arterial wall and offers the potential for precise quantitative assessment of disease progression on serial examinations. The present study was done to test the feasibility of serially assessing intimal proliferation at the same coronary site with ICUS imaging in cardiac transplant recipients.