Device-based therapy for mitral regurgitation and ventricular reshaping

C Tenorio, N González, JS Jaramillo, G Ong, D Burkhoff, I Kronzon, P Perier and F Kleber
Structural Heart

Background: A clinically effective treatment for functional mitral regurgitation (fMR) due to left ventricular (LV) remodeling may need to address both annular and LV dilation to improve symptoms of heart failure (HF). Here we describe the effects of a device intended to reduce mitral annular dimensions and also reduce the radius of curvature of the LV to improve function.
Methods: Patient 202–051 is a 79-year-old man with ischemic cardiomyopathy and 3-to-4+ fMR treated with guideline recommended HF therapies. Echocardiography showed an effective regurgitant orifice (ERO) of 0.36 cm2, a regurgitant stroke volume of 69 ml, an LVEF of 14% and an LV diastolic diameter of 6.2 cm. The patient underwent percutaneous implantation of the Ancora Heart device which consists of a series of intramyocardial anchors connected via a cinching cable implanted into the LV free wall below the mitral annulus and behind the papillary muscles. Tension applied to the cable resulted in an acute ~15% decrease of the circumferential distance between the first and last anchors. Cinching was maintained with a locking mechanism placed at the end of the cable.
Results: Echocardiographic follow up performed over the course of 1 year showed that ERO decreased to 0.12 cm2, regurgitant stroke volume to 23 ml, LV dimension to 5.6 cm and EF improved to 34%. ntPro-BNP decreased from 3440 to 1450 pg/ml.
Conclusion: These findings provide proof-of-concept that a percutaneously deployable, sub-valvular intramyocardial implant that cinches the myocardial wall below the mitral annulus has the potential to reduce the severity of fMR and improve LV function.

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