Yugal Mishra. Marco Zenati. A short summary of this paper. Download Download PDF. Translate PDF. Subramanian, Ted Feldman, Robert C. Coapsys is a ventricular shape change device placed without cardiopulmonary bypass to reduce FMR. The device compresses the mitral annulus and positively reshapes the ventricle. We hypothesized Coapsys therapy for FMR would improve clinical outcomes when compared to standard therapies. As-treated analysis revealed an initial decrease in LV control arm and Although the effect of 5.
Coapsys started with an average resting transventricu- Discussion lar chordal length of 8. B All patients; adjusted log-rank. CABG had improved survival at 2 years. In the surviving pump, less invasive placement. Superior safety may convey the previously reported benefits of isolated of the procedure was also documented, with fewer PAEs off-pump coronary revascularization, such as decreased in the Coapsys treatment group.
Because a significant inotrope dependence, decreased bleeding and transfusion, portion of PAEs occurred in the early perioperative time faster intensive care unit recovery, and shorter length of frame, Coapsys may confer an advantage from its off- hospital stay Abbreviations as in Figures 3 and 4. The survival benefit in the Coapsys group may result from was related to the ventricular shape change effected by the several factors, including the lower PAE rate and the device.
The Coapsys has an acute positive reshaping effect possible benefit of the combined MR treatment in conjunc- on the entire ventricle, whereas the effect of traditional tion with LV wall stress reduction. Although the control annuloplasty is limited to the base of the ventricle This annuloplasty stratum did show a greater decrease in MR, effect was demonstrated again in the current trial with twice this did not translate into improved survival or better the initial decrease in LV end-diastolic dimension in pa- symptom reduction.
In this high-risk Baseline 2. Study limitations. However, recruitment was very near the U. It is additionally possible set in place to limit the perceived high early mortality in that the long-term survival benefit seen with the device is such patients, which would limit the discriminatory power due to a global and progressive reversal of LV remodeling, of the device trial.
This trial did not perform myocardial which was seen in the earlier TRACE Treatment of viability testing, and it was not always possible to distinguish Functional Mitral Regurgitation without Atriotomy or symptoms of coronary disease from symptoms of MR. CPB Clinical Evaluation study The population, particularly when all patients were being revas- Coapsys method decreases wall stress by changing the cularized.
The echocardiography laboratory was not blinded chamber shape rather than decreasing chamber size by to therapy; interobserver and intraobserver variability is not excluding a dyskinetic wall.
Additionally, the effect of inflow restriction is not well We have described a novel off-pump surgical therapy, Coapsys, understood when restrictive annuloplasty is used to treat which simultaneously reshapes both the left ventricle and the FMR; one study demonstrated dynamic mitral stenosis after mitral annulus with the intent of treating FMR. On the basis such treatment This unique approach Finally, the greater invasiveness of the STICH ap- to reshaping the left ventricle and treating the valve has effected proach compared with Coapsys may contribute to the a meaningful impact on the clinical outcomes of patients with difference in outcome for these LV remodeling approaches.
Two questions arise when looking at these data: Are the control outcomes representative of previous reports? Eugene A. E-mail: grossi cv. J Thorac Cardiovasc Surg ;— Survival after coronary Comparison of Coapsys revascularization, with and without mitral valve surgery, in patients annuloplasty and internal reduction mitral annuloplasty in the ran- with ischemic mitral regurgitation. Circulation ; Suppl 1:II- domized treatment of functional ischemic mitral regurgitation: impact — J Thorac Cardiovasc Surg ;— 8.
Geometric determinants of Coronary bypass surgery ischemic mitral regurgitation. Circulation ;II — N Engl J Med 3. Mitral valve repair for ;— Ann Thorac Surg ; —51, Optimal mitral annular and discussion 51—2. J Am Coll Cardiol function in the failing heart: a finite element model study. Ann Thorac ;e1— Surg ;— 80, discussion Does coronary artery bypass Circu- Restrictive annuloplasty for ischemic mitral regurgitation may induce lation ;I68 — J Am Coll Cardiol ;— Restrictive annuloplasty and coronary The STICH trial: misguided con- revascularization in ischemic mitral regurgitation results in reverse left clusions.
J Thorac Cardiovasc Surg ; — 4. Circulation ;II— 8. Mitral valve procedure Background: FMR occurs when ventricular remodeling impairs valve function. Coapsys is a ventricular shape change device placed without cardiopulmonary bypass to reduce FMR. It compresses the mitral annulus and reshapes the ventricle. We hypothesized that Coapsys for FMR would improve clinical outcomes compared with standard therapies.
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