Transcatheter pledget-assisted suture tricuspid annuloplasty (PASTA) to create a double-orifice valve.

ABSTRACT: OBJECTIVES:Pledget-assisted suture tricuspid valve annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice tricuspid valve. BACKGROUND:Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. METHODS:Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice tricuspid valve. RESULTS:Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1?±?0.8 cm2 to 3.8?±?1.5 cm2 (naïve) and 13.1?±?1.5 cm2 to 6.2?±?1.0 cm2 (diseased); septal-lateral diameter, 3.9?±?0.3 mm to 1.4?±?0.6 mm (naïve) and 4.4?±?0.4 mm to 1.7?±?1.0 mm (diseased); and right ventricular end-diastolic volume, 94?±?13 ml to 85?±?14 ml (naïve) and 157?±?25 ml to 143?±?20 ml (diseased)). MRI derived tricuspid regurgitation fraction fell from 32?±?12% to 4?±?5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6?±?11.7N vs 8.0?±?2.6N, P?

SUBMITTER: Khan JM 

PROVIDER: S-EPMC6078835 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature