Objectives: Restrictive downsizing annuloplasty reduces the septolateral (SLD) by circumferential annular cinching and is currently considered surgical therapy of choice for functional mitral regurgitation (FMR). However, recurrence of FMR is a major clinical concern. Direct reduction of SLD without circumferential rigid downsizing of the mitral annulus (MA) using a novel nitinol-silicon transvalvular bridging device allows for aggressive downsizing without the risk of functional mitral stenosis.

Methods: The transvalvular bridge device (MitralBridge^TM, HeartRepairTechnologies, Inc., CA, USA) has received CE mark in an earlier study and is presently evaluated in a post-market registry aiming to include 60 patients with severe mitral regurgitation.

Results: The implant has a central curvilinear nitinol skeleton covered by a silicone over-mold with velour pads at either ends for annular suturing in the A2 / P2 regions. Five sizes are available (22-30 mm) to address a wide range of annular dimensions. Reduction of SLD can be achieved without circumferential rigidification of the MA and without reduction of the intercommissural diameter. The device can also be successfully implanted via a fully endoscopic minimally-invasive mitral valve repair approach.

Conclusions: Direct reduction of SLD without circumferential and intercommissural cinching of the MA allows for aggressive downsizing without the risk of inducing relevant mitral stenosis. The transvalvular bridge concept preserves normal annular dynamics and may relieve the issue of FMR recurrence. A transcatheter extension is under development.