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Development and Application of Polymer-Matrix Device to Remodel Left Ventricular - Mitral Valve Apparatus in Ischemic Mitral Regurgitation
Akihisa Kataoka, Timothy Tan, Xin Zeng, Michael Garcia, Margo Seybolt, Suzanne Sullivan, Jose Guerrero, Mark Handschumacher, Robert Levine,
Judy Hung.
Massachusetts General Hospital, Boston, MA, USA.

OBJECTIVE: Ischemic mitral regurgitation (IMR) results from mitral valve (MV) tethering by ischemic left ventricular (LV) distortion. We aimed to explore a novel approach to treat IMR by applying a polymer-filled polyester mesh attached to the epicardium of the infarcted myocardium. This poly-mesh can provide direct and adjustable reverse LV remodeling, stabilizing the infarcted wall to reduce IMR.
METHODS: Eight sheep underwent ligation of circumflex (LCX) branches to produce IMR. Solid polymer granules were enclosed within 2 layers of polymesh. The poly-mesh was attached to infarcted LV and soaked with saline to produce a stable polymer gel of specified volume and compressibility within the mesh. 2D/3D echo and hemodynamic data were obtained (baseline, pre and post poly-mesh), with IMR assessed by 2D vena contracta (VC).
RESULTS: Moderate IMR developed in all sheep post LCX ligation (VC:0.50±0.09). After poly-mesh attachment, the MR decreased to trace or mild (VC: 0.50±0.09 to 0.26±0.12 cm; p<0.01. LV volume, MV annular and leaflet areas decreased with poly-mesh while wall stress and dP/dtMAX improved (68±27 to 41±20 dyne/cm2, 684±106 to 969±141 mmHg/s, respectively; p<0.01).
CONCLUSIONS: Polymer-mesh provides a direct reverse remodeling approach to reduce IMR and stabilize LV remodeling.

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