Sutureless Mitral Valve Replacement: Initial Steps Toward a Percutaneous Procedure Matthew J. Gillespie, MD, Masahito Minakawa, MD, Masato Morita, MD,

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Sutureless Mitral Valve Replacement: Initial Steps Toward a Percutaneous Procedure Matthew J. Gillespie, MD, Masahito Minakawa, MD, Masato Morita, MD, Mathieu Vergnat, MD, Kevin J. Koomalsingh, MD, J. Daniel Robb, MBBS, MRCP, Norihiro Kondo, MD, PhD, Takashi Shuto, MD, Manabu Takebe, MD, Toru Shimaoka, MD, Jeremy R. McGarvey, MD, Robert C. Gorman, MD, Joseph H. Gorman, MD The Annals of Thoracic Surgery Volume 96, Issue 2, Pages 670-674 (August 2013) DOI: 10.1016/j.athoracsur.2013.02.065 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The sutureless mitral valve replacement device consists of a frame constructed from a single nitinol wire that is woven into a complex three-dimensional geometry engineered to provide a housing for the valve mechanism and anchoring forces to ensure secure position within the mitral annulus. (A) The device as seen from the side. (B) The device as seen from the ventricular side. The valve leaflets are constructed from porcine pericardium. The Annals of Thoracic Surgery 2013 96, 670-674DOI: (10.1016/j.athoracsur.2013.02.065) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The 30F sutureless mitral valve delivery device. The Annals of Thoracic Surgery 2013 96, 670-674DOI: (10.1016/j.athoracsur.2013.02.065) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Epicardial echocardiographic assessment after cessation of cardiopulmonary bypass. (A) En face color Doppler interrogation of the sutureless mitral valve device from the left atrium is shown. There is no perivalvular lead and only trivial central mitral regurgitation (MR). (B) Low-velocity flow from the left atrium through the sutureless mitral valve into the left ventricle is shown. There is no stenosis. The Annals of Thoracic Surgery 2013 96, 670-674DOI: (10.1016/j.athoracsur.2013.02.065) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Angiographic assessment of the sutureless mitral valve (SMV) device, 6 hours postoperatively. The device is securely anchored. There is no mitral regurgitation (MR; A), no left ventricular outflow tract (LVOT) obstruction (A), and no aortic valve insufficiency (AI; B). (C, D) Selective left coronary angiography after sutureless mitral valve device implantation. The left coronary system is undisturbed by the sutureless mitral valve device. (Cx = circumflex artery; LA = left atrium; LAD = left anterior descending artery; LCA = left coronary artery; LV = left ventricle; RCA = right coronary artery.) The Annals of Thoracic Surgery 2013 96, 670-674DOI: (10.1016/j.athoracsur.2013.02.065) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Postmortem pictures of the sutureless mitral valve device from the left atrial (A) and left ventricular (B) perspectives. The atrial arms gather the supraannular tissue centrally, and the ventricular arms entrap the mitral leaflets between the arms and the body of the sutureless mitral valve. The sutureless mitral valve ventricular arms also enmesh with the mitral chordae. The Annals of Thoracic Surgery 2013 96, 670-674DOI: (10.1016/j.athoracsur.2013.02.065) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions