Search

Background: There is certain experimental and clinical evidence indicating that the covering of bare metal stents (BMS) with drug eluting polymers to produce drug eluting stents (DES) results in increased stent stiffness and modifies the mechanical properties of the stent platform. In addition, it has been speculated that the mechanical performance of DES, compared to BMS, may be related to the type of polymer used to cover stents., Aim: We aimed at evaluating the deliverability of DES with a lactate based biodegradable polymer and BMS in patients with stable coronary artery disease in a prospective randomised study., Methods: One hundred eleven consecutive patients (age: 36-77, mean 58.8 years) scheduled for routine angioplasty due to stable coronary disease were randomised to receive BMS (Chopin II(TM), Balton, Poland) or paclitaxel eluting stent (Chopin Luc(TM), Balton, Poland) using the same metal platform. Only patients scheduled for angioplasty using the direct implantation technique of a single stent were randomised. The exclusion criteria included patients 〉 80 years, multivessel disease and reference diameter of the target vessel 〉 3.5 mm., Results: In the BMS group (n = 55; 35 males and 20 females), the mean diameter of implanted stents was 3.09 ± 0.40 and the mean length was 11.37 ± 2.80, whereas in the DES group (n = 56; 34 males and 22 females) the mean stent sizes were 3.02 ± 0.34 and 17.90 ± 7.38 mm, respectively (p 〉 0.05 for length). The groups did not significantly differ regarding the frequency of stent implantation to particular coronary vessels. The direct stenting technique was attempted and failed, leading to the stents' implantation after predilatation in five patients in the BMS group and six patients in the DES group. Failure of stent implantation and subsequent implantation of another stent type was observed in no BMS patients and in one DES patient (NS)., Conclusions: Although stent covering with lactate based drug eluting polymer may increase its stiffness, it does not affect its deliverability in patients with stable coronary disease.

Background: Functional mitral regurgitation (MR) due to dilated cardiomyopathy or coronary artery disease remains a significant clinical problem. These clinical entities lead to left ventricular enlargement, which results in annular dilation and MR. Surgical valvuloplasty is associated with a high perioperative risk. This is the reason why percutaneous techniques for mitral valve repair are under development. One of the most advanced devices for mitral annuloplasty is the Carillon™ system., Aim: Functional assessment of patients who have undergone mitral annuloplasty using the Carillon™ device., Methods: Fourteen consecutive patients with functional MR who had undergone successful implantation of the Carillon™ device were enrolled. The device was implanted into the venous system of the heart and applied tension to the mitral annulus in order to improve coaptation of the cusps and reduce MR. In implanted patients echocardiographic MR parameters (vena contracta, effective regurgitant orifice area) were assessed before, immediately after the procedure and during 1-month follow-up. Furthermore, the 6-minute walk test (6MWT), Naughton stress test and the NYHA functional class assessment were performed before the procedure and at 1 month. Quality of life was evaluated by the Kansas City Cardiomyopathy Questionnaire. One month after the procedure patients were also asked to compare their health status with their baseline condition., Results: In implanted patients improvement of echocardiographic MR parameters was observed, both immediately after the procedure and during 1 month follow-up. These parameters included vena contracta (0.36 ± 0.03 and 0.31 ± 0.03 vs 0.65 ± ± 0.04 cm, both p < 0.001) as well as effective regurgitant orifice area (0.18 ± 0.02 and 0.20 ± 0.02 vs 0.28 ± 0.04 cm², p < 0.05 and p < 0.005, respectively). One month after the procedure the 6MWT (390 ± 26.25 vs 311.9 ± 15.71 m, p < 0.001), Naughton treadmill exercise test (5.06 ± 0.47 vs 3.49 ± 0.27 min, p < 0.005) and NYHA classification (1.93 ± ± 0.20 vs 2.93 ± 0.07, p < 0.005) were significantly improved. Quality of life improved from 67.93 ± 3.30 at baseline to 88.31 ± 4.02 at 1 month (p < 0.001). All the patients reported some degree of improvement at 1 month compared to baseline., Conclusions: Implantation of the Carillon™ device in patients with functional MR leads to increased exercise capacity and improvement of selected echocardiographic MR parameters. Randomised trials are needed to assess the clinical value of the technique. Kardiol Pol 2011; 69, 3: 228-233.

Background: Dilated cardiomyopathy is characterised by significant enlargement of cardiac chambers, which can lead to functional mitral regurgitation. Surgery is a widely accepted treatment of secondary mitral regurgitation. Conventional cardiac surgery has a high procedural risk and therefore new techniques for percutaneous repair of mitral valve are being developed. The CARILLON system is one of devices that is implanted into the coronary venous system, which enables tension of the mitral ring in order to improve coaptation of the leaflets., Aim: Echocardiographic analysis of the CARILLON system implantation efficacy evaluated directly and one month after implantation., Methods: The study in included 9 patients, aged 58.56 +/- 6 years, with severe functional mitral regurgitation, who fulfilled the following echocardiographic criteria: large central jet ł 4 cm(2) or ł 20% of the left atrium area or wall-impinging eccentric jet reaching the pulmonary veins, vena contracta (VC) ł 0.30 cm, effective regurgitant orifice area (ERO) ł 0.2 cm(2), regurgitant volume (RV) ł 30 ml or regurgitant fraction (RF) > 30%. Exclusion criteria were: concomitant severe tricuspid valve insufficiency, significant organic mitral valve pathology, chronic atrial fibrillation, foreign body in the coronary sinus, or thrombus in the left atrial appendage. The prerequsite for implanting the device was a significant reduction in the mitral regurgitation jet observed by transesophageal echo-cadiography (TEE), seen during the procedure. After one month, a transthoracic echocardiography (TTE) was performed to evaluate mitral regurgitation by analysing the same parameters assessed before implanting CARILLON to the coronary sinus., Results: A significant improvement of VC after the procedure, in comparison to the value before the procedure (0.43 +/- 0.12 vs. 0.66 +/- 0.14 cm, p < 0.05), was observed. This improvement was lower one month after the implantation of the device (0.35 +/- 0.1 cm, p < 0.005). The ratio of the jet area to the left atrial area was reduced from 54.96 +/- 11.18% to 38.57 +/- 9.79% (p < 0.005) and sustained after a month at 36.33 +/- 10.15% (p < 0.005). Other echocardiographic parameters of evaluation of mitral regurgitation tended to improve, however the differences did not reach statistical significance. The ERO in subsequent studies was: 0.25 +/- 0.09 cm(2), 0.23 +/- 0.07 cm(2), and 0.24 +/- 0.07 cm(2), and RV decreased from 33.06 +/- 11.81 ml before the procedure, to 32.33 +/- 7.84 ml one month after the procedure., Conclusions: The CARILLON system implantation to the coronary venous system in patients with secondary mitral regurgitation can lead to the improvement of selected echocardiographic indices of mitral regurgitation.

Mitral regurgitation may result from left ventricular dilatation and cause progression of heart failure. Percutaneous techniques for mitral valve repair are under development. Techniques utilizing a trans-coronary venous approach exploit the anatomical relationship between the mitral annulus and the venous system of the heart. The coronary sinus, great cardiac vein and the origin of the anterior interventricular vein surround the posterior mitral annulus. This enables percutaneous approaches to annuloplasty for mitral regurgitation. Devices can be implanted into the coronary veins that modify the shape and size of the mitral annulus. We present a case of ischaemic mitral regurgitation successfully treated by use of a percutaneous approach, the Carillon Mitral Contour System. Significant reduction of the mitral regurgitation jet was observed. The patient was discharged 4 days after the procedure. During the follow-up visits, the patient showed an improved general condition and increased exercise capacity. Procedural steps are shown in detail and the current status of the coronary sinus based technique is discussed. Percutaneous techniques for mitral valve repair may be an attractive alternative to cardiac surgery in heart failure patients with secondary mitral regurgitation. The Carillon Mitral Contour System is under ongoing clinical evaluation in the AMADEUS trial.