The need for structural repairs of the heart can be due to congenital deformities or the progression of cardiac disease. These structural problems can be repaired during open-heart procedures requiring cardiopulmonary bypass, using minimally invasive surgical approaches (off-pump) or transcatheter delivery systems.
Annuloplasty devices: Annuloplasty devices are used to reduce valve regurgitation by pulling the leaflets together to reduce undesired backflow. Annuloplasty rings can be directly placed on the valve annulus. Direct annuloplasty is typically performed via open-heart surgery to access the valve. Indirect annuloplasty involving a device in the coronary sinus has been investigated to reduce mitral regurgitation. However, there is a risk of compromising blood flow of the nearby circumflex artery.
Edge to Edge Procedure: The Edge to Edge Procedure is a technique used to treat mitral regurgitation. The leaflets of the mitral valve are stitched together to create two smaller openings to reduce backflow. New products, such as the MitraClip, can deliver this technique through a transcatheter approach.
(figure from www.abbottvascular.com)
Coronary Bypass: Coronary Bypass is a surgical method used to treat coronary artery disease. When a coronary artery is narrowed or obstructed, a vessel (typically from elsewhere in the patients) can be used to bypass the narrowed artery. One end of the vessel is typically attached to the aortic root or left subclavian artery. The other end is attached distal to the narrowed portion of the artery so that oxygenated blood can reach that part of the myocardium, hence the occluded coronary region is bypassed.
Septal Closure Devices: Atrial or ventricular septal defects are congenital deficiencies in the heart walls separating systemic and pulmonary circulations within the heart. In the case of an atrial defect, blood from the lungs flows through the defect and increases the volume of blood passing through the pulmonary arteries. For individuals living with such defects, permanent damage to pulmonary vasculatures can eventually occur. Cardiac surgical procedures or transcatheter delivered technologies (septal closure devices) can be employed to close these septal defects.