Mitral annular techniques

Abstract

Transcatheter approaches to mitral annuloplasty for treating mitral regurgitation (MR) are in various stages of development. Initial efforts targeted the coronary sinus because it is easy to access percutaneously. However, the coronary sinus does not completely encircle the mitral annulus, is often too superior to the annulus to affect it, and the circumflex coronary artery may easily be compressed. Therefore, coronary sinus approaches have largely been abandoned. Direct annuloplasty via the LV or LA approach has been done in humans using the Mitralign system, the Accucinch system, and the Cardioband system. All are in clinical trials and offer the potential for beating heart mitral annuloplasty in patients who are too sick to undergo traditional surgery. On the other hand, disappointing results with surgical annuloplasty in recent trials of secondary MR may limit the clinical applicability of these devices.