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Ramot Y, Rousselle SD, Yellin N, Willenz U, Sabag I, Avner A, Nyska A. Biocompatibility and Systemic Safety of a Novel Implantable Annuloplasty Ring for the Treatment of Mitral Regurgitation in a Minipig Model. Toxicol Pathol 2016; 44:655-62. [DOI: 10.1177/0192623315627217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prosthetic annuloplasty rings are a common treatment modality for mitral regurgitation, and recently, percutaneous implantation techniques have gained popularity due to their favorable safety profile. Although in common use, biocompatibility of annuloplasty rings has been reported only sparsely in the literature, and none of these reports used the percutaneous technique of implantation. We report on the biocompatibility and the systemic safety of a novel transcatheter mitral valve annuloplasty ring (AMEND™) in 6 minipigs. This device is composed of a nitinol tube surrounded by a braided polyethylene terephthalate fabric tube. The device produced no adverse inflammatory response, showing gradual integration between the metal ring and the fabric by normal host fibrocellular response, leading to complete neoendocardium coverage. There was no evidence for adverse reactions, rejection, or intolerance in the valvular structure. In 2 animals, hemopericardium resulted from the implantation procedure, leading to right-sided cardiac insufficiency with pulmonary edema and liver congestion. The findings reported herein can serve as a case study for the expected healing pathology reactions after implantation of transcatheter mitral valve annuloplasty rings.
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Affiliation(s)
- Yuval Ramot
- Hadassah—Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Udi Willenz
- The Institute of Animal Research, Kibbutz Lahav, Israel
| | - Itai Sabag
- The Institute of Animal Research, Kibbutz Lahav, Israel
| | | | - Abraham Nyska
- Tel Aviv University and Consultant in Toxicologic Pathology, Timrat, Israel
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Borisenko O, Haude M, Hoppe UC, Siminiak T, Lipiecki J, Goldberg SL, Mehta N, Bouknight OV, Bjessmo S, Reuter DG. Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings. BMC Cardiovasc Disord 2015; 15:43. [PMID: 25971307 PMCID: PMC4443594 DOI: 10.1186/s12872-015-0039-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the prolongation of optimal medical treatment (OMT). METHODS Cost-utility analysis using a combination of a decision tree and Markov process was performed. The clinical effectiveness was determined based on the results of the Transcatheter Implantation of Carillon Mitral Annuloplasty Device (TITAN) trial. The mean age of the target population was 62 years, 77% of the patients were males, 64% of the patients had severe FMR and all patients had New York Heart Association functional class III. The epidemiological, cost and utility data were derived from the literature. The analysis was performed from the German statutory health insurance perspective over 10-year time horizon. RESULTS Over 10 years, the total cost was €36,785 in the PMVR arm and €18,944 in the OMT arm. However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years. The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY. Results were robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective. CONCLUSIONS Percutaneous mitral valve repair may be cost-effective in inoperable patients with FMR due to heart failure.
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Affiliation(s)
| | - Michael Haude
- Medical Clinic I, Neuss City Clinic, Lukas Krankenhaus GmbH, Preußenstraße 84, 41464, Neuss, Germany.
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, A-5020, Salzburg, Austria.
| | - Tomasz Siminiak
- Department of Cardiology, Interventional Cardiology, HCP Medical Center, Poznan University of Medical Sciences, ul. 28 czerwca 1956 Nr 194, 61-485, Poznan, Poland.
| | - Janusz Lipiecki
- Pole Sante Republique, 105 Avenue de la République, 63050, Clermont-Ferrand, France.
| | - Steve L Goldberg
- Department of Cardiology, University of Washington, Seattle, WA, USA.
| | - Nawzer Mehta
- Cardiac Dimensions Incorporated, 5540 Lake Washington Blvd NE, Kirkland, WA, 98033, USA.
| | - Omari V Bouknight
- Cardiac Dimensions Incorporated, 5540 Lake Washington Blvd NE, Kirkland, WA, 98033, USA.
| | - Staffan Bjessmo
- Synergus AB, Svardvagen 19, 182 33, Danderyd, Sweden. .,Department of Learning Informatics, Medical Management Centre, Management and Ethics, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden.
| | - David G Reuter
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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