Park Matthew H, Imbrie-Moore Annabel M, Paulsen Michael J, Zhu Yuanjia, MacArthur John W, Woo Y Joseph
Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
Cardiovasc Eng Technol. 2025 Apr;16(2):251-257. doi: 10.1007/s13239-024-00764-9. Epub 2024 Dec 26.
Advancements in minimally invasive technologies to decrease postoperative morbidity and recovery times represent a large opportunity for mitral valve repair operations. However, current technologies are unable to replicate gold standard surgical neochord implantation.
We developed a novel neochordal repair device, Minimally Invasive Ventricular Anchoring Neochordoplasty (MIVAN), which operates via transcatheter, trans-septal anchoring to the posterior ventricular wall. We evaluated MIVAN in an ex vivo heart simulator and compared it with surgical neochordal repair and MitraClip using a prolapse model.
Upon MIVAN repair of the model (n = 5), regurgitant fraction was reduced from 19.46 ± 1.77% to 7.30 ± 0.99% (p = 0.01). Surgical neochordal repair reduced regurgitant fraction to 5.65 ± 0.66%, but there was no significant difference between MIVAN and surgical repair (p = 0.22). Unpaired MitraClip repair had significantly higher regurgitant fraction of 11.9 ± 1.40%, compared with those of neochord (p < 0.01) and MIVAN (p = 0.03) repairs.
MIVAN represents a high-value opportunity for minimally invasive mitral valve repair. The benefits of the percutaneous, trans-septal approach for implantation on the posterior ventricular wall necessitate the expanded exploration of this device as a treatment alternative.
微创技术的进步以降低术后发病率和恢复时间，这为二尖瓣修复手术带来了巨大机遇。然而，目前的技术无法复制金标准的外科新腱索植入术。
我们开发了一种新型的新腱索修复装置，即微创心室锚定新腱索成形术（MIVAN），它通过经导管、经房间隔锚定到心室后壁来操作。我们在体外心脏模拟器中评估了MIVAN，并使用脱垂模型将其与外科新腱索修复和MitraClip进行了比较。
在对模型进行MIVAN修复后（n = 5），反流分数从19.46±1.77%降至7.30±0.99%（p = 0.01）。外科新腱索修复将反流分数降至5.65±0.66%，但MIVAN与外科修复之间无显著差异（p = 0.22）。与新腱索修复（p < 0.01）和MIVAN修复（p = 0.03）相比，未配对的MitraClip修复的反流分数显著更高，为11.9±1.40%。
MIVAN是微创二尖瓣修复的一个高价值机遇。经皮、经房间隔方法植入到心室后壁的益处使得有必要进一步探索将该装置作为一种治疗选择。
