Abbott’s Tendyne transcatheter mitral valve replacement (TMVR) offers an alternative to MitraClip for patients with symptomatic, moderate-severe mitral regurgitation who are not suitable candidates for a traditional, open surgical mitral valve replacement. The ongoing, multicenter, international SUMMIT Trial will be looking at outcomes over the next few years.
After preoperative planning, the Tendyne procedure begins with a small incision in the left chest to access the left ventricular (LV) apex. Then, with transesophageal echocardiography (TEE) and fluoroscopy, a wire is passed from the LV apex into the left atrium (LA), often with a balloon-tipped catheter to avoid entraining any of the submitral apparatus (namely chordae tendineae, papillary muscles, etc.) Next, purse strings are placed on the LV apex, and the Tendyne delivery sheath is threaded onto the wire into the LA.
The Tendyne valve is oriented appropriately, stabilized, and slowly deployed within the native mitral valve. Tension is applied to a tether anchored to an epicardial pad on the surface of the LV apex to support and secure the valve’s position.
This procedure requires coordination between the surgeons, anesthesiologists, and cardiologists due to the potential for hemodynamic changes from acute left ventricular loading, left ventricular outflow tract obstruction, blood loss, positioning, etc.