Abstract:

Mitral valve (MV) insufficiency is the second most common heart valve disease represented in cardiac surgery. The gold standard therapy is surgical repair of the valve. Today, most centers prefer a minimally invasive approach through a right-sided mini-thoracotomy. Despite the small access, there is still the need to use cardiopulmonary bypass (CPB), and the operation has to be performed on the arrested heart. New devices have been developed to optimize the results of surgical repair by implementing mechanisms for post-implantation adjustment on the beating heart or the avoidance of CPB. Early attempts with adjustable mitral annuloplasty rings go back to the early 1990s. Only a few devices are available on the market. Recently, a mitral valve adjustable annuloplasty ring was CE-marked and is under further clinical investigation. In addition, a sutureless annuloplasty band to be implanted on the beating heart is under preclinical and initial clinical investigation for transatrial and transfemoral transcatheter implantation. Furthermore, new neochord systems are being developed, which allow for functional length adjustment on the beating heart after implantation. Some devices were developed for percutaneous MV repair implanted into the coronary sinus to reshape the posterior MV annulus. Other percutaneous devices are directly fixed to the posterior annulus to alter its shape. Several disadvantages have been observed preventing a broad clinical use of some of these devices. There is a continuous effort to develop innovative techniques to optimize MV repair and to decrease invasiveness.

Authors:

Simon H. Sündermann, MD Resident, Division of Cardiovascular Surgery University Hospital Zurich, Zurich, Switzerland, Jöerg Seeburger, MD, Consultant, Heart Center, University of Leipzig, Clinic for Cardiac SurgeryLeipzig, Germany, Jacques Scherman, MD, Consultant, Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland, Friedrich Wilhelm Mohr, MD, PhD, Chief of Clinic, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Volkmar Falk, MD, PhD, Chief of Division, Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland

PMID: 23315719

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Abstract:

The paradigm in elective surgical management of infrarenal abdominal aortic aneurysms (AAAs) has quickly shifted from major open surgical repairs to less invasive, endovascular procedures. In the last few years, there have been numerous advancements to commercially available devices making the endovascular approach more attractive and efficacious. This review serves to detail the similarities, differences, advantages, and disadvantages of currently available endovascular stent-grafts as well as preview future and emerging technologies in endovascular aortic therapies.

Authors:

Angela A. Kokkosis, MD, Resident, Vascular Surgery, Steven Abramowitz, MD, Resident, Vascular Surgery, Rajesh K. Malik, MD, Assistant Professor of Surgery, Assistant Professor of Radiology, Sharif H. Ellozy, MD, Associate Professor of Surgery, Associate Professor of Radiology, Associate Professor of Medical Education, Peter L. Faries, MD, Franz W. Sichel Professor of Surgery ,Professor of Radiology, Chief, Division of Vascular Surgery, Michael L. Marin, MD, Julius H. Jacobson II, MD, Professor of Surgery, Chairman, Department of Surgery, Division of Vascular Surgery, Mount Sinai Medical Center, New York, New York

PMID: 23315722

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