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Review
. 2020 Jul-Sep;23(3):321-326.
doi: 10.4103/aca.ACA_200_18.

Intensive care and anesthesia management for HARPOON beating heart mitral valve repair

Paul Diprose  1 , Katheryn J Fogg  2 , Demetrio Pittarello  3 , James S Gammie  4 , Michael N D'Ambra  5
Affiliations
Review

Intensive care and anesthesia management for HARPOON beating heart mitral valve repair

Paul Diprose et al. Ann Card Anaesth. 2020 Jul-Sep.

Erratum in

Abstract

Patients with severe mitral valve regurgitation secondary to degenerative disease are known to benefit from mitral valve repair surgery. Novel techniques for achieving mitral valve repair on the beating heart have been developed and are being introduced into clinical practice. The HARPOON Beating Heart Mitral Valve Repair System (MVRS) in recent studies has demonstrated efficacy and safety for the repair of degenerative mitral valve disease on the beating heart. The device uses transoesophageal echocardiographic guidance to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on prolapsed mitral valve leaflets in the beating heart. It requires general anaesthesia and there are specific intensive care and anaesthesia considerations for the safe management of these cases. This article describes the general principles of intensive care and anaesthesia management employed for the initial patients treated with the HARPOON Beating Heart MVRS, the outcomes for these patients, and the potential challenges for the future management of these cases.

Keywords: Cardiovascular anaesthesia and surgery; catheter-based coronary and valvular interventions; image guidance; mitral valve repair; transesophageal echocardiography; valvular heart disease.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Diagram demonstrating deployment and tensioning of the HARPOON Beating Heart MVRS. (a) Needle fired through prolapsed mitral valve leaflet, (b) Knot deployed on atrial surface of mitral valve, (c) Harpoon cord appropriately tensioned. Reproduced with permission from: Gammie JS, Bartus K, Gackowski A et al., Beating-Heart Mitral Valve Repair Using a Novel ePTFE Cordal Implantation Device: Prospective Trial. Journal of the American College of Cardiology, 2018 Jan; 71(1): 25-36
Figure 2
Figure 2
TEE image (mid-esophageal long-axis view), illustrating some of the measurements made when screening for suitability for HARPOON Beating Heart MVRS. Particular importance is made to the ratio between PMVL length (orange line) and the distance between the base of PMVL and the tip of the AMVL (blue line). Note that multiple measurements are made along the breadth of the prolapse, one for each target position for a HARPOON cord. These measurements are made at the peak of the T wave of the electrocardiogram to standardize for multiple measurements
Figure 3
Figure 3
Suggested placement of external defibrillator pads to avoid both the areas of planned incision for the HARPOON Beating Heart MVRS (usually the 3rd or 4th left intercostal space), and a median sternotomy (should it be required). (a) Anterior chest wall, (b) Posterior chest wall. Reproduced with permission from: Cheung AT. Anesthesia for aortic surgery requiring deep hypothermia. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA (accessed on 3rd February 2018) Copyright © 2018 UpToDate, Inc. For more information visit www.uptodate.com
See this image and copyright information in PMC

References

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