Initial results have been promising,34 and it is now available for commercial implantation in Europe within a prospective post-market registry (PRIME) on-going to assess long-term safety and efficacy in up to 300 patients. Figure 3 Coronary Sinus Annuloplasty: the CARILLON Concept. A previously investigated NVP-BKM120 mw device was the Edwards Monarc (Edwards Lifesciences, Irvine, USA)33 that consists in a distal anchor placed at the transition between the anterior interventricular vein and the GCV, a proximal anchor placed in the ostial CS, and a spring-like bridge connecting

the two. Further evaluation Inhibitors,research,lifescience,medical was suspended due to the slow enrollment in the dedicated clinical trial, but more importantly due to an excessive (and unexpected) rate of complications, including coronary occlusions. The Viacor PTMA (Viacor, Wilmington, Inhibitors,research,lifescience,medical USA)35 was made up of a plastic CS catheter containing up to

three nitinol rods to provide incremental cinching/pushing of the posterior annulus. PTMA investigations have been suspended due to a series of device-related adverse events, including circumflex artery occlusion and fatal CS perforation.31,36,37 A more aggressive concept has been developed by the National Institute of Health. The Inhibitors,research,lifescience,medical Mitral Cerclage (NIH, Rockville, USA) creates a loop around the mitral annulus and left ventricular outflow tract (LVOT), entering through the CS ostium, passing through the anterior interventricular vein and returning near the CS ostium, perforating the myocardium either Inhibitors,research,lifescience,medical coming out in the right ventricle and passing through the anterior tricuspid commissure, or directly coming out through the septum in the right atrium; the loop is then tightened and secured near the CS ostium.38 Differently from the other coronary sinus devices, Inhibitors,research,lifescience,medical the Mitral Cerclage offers the opportunity of circumferential remodeling of the mitral annulus, using the coronary sinus as a support. Cinching Devices These technologies force septo-lateral annular reduction through the approximation of two devices connected by a bridge. The reduction of this

dimension is expected to be particularly important for MR reduction and in the ALOX15 functional setting.39 The Ample PS3 System (Ample Medical, Inc., Foster City, CA, USA) consists of a CS anchor (“T bar”) and an interatrial septal anchor at the level of the fossa ovalis linked by an adjustable bridge; the device is designed for specific septal-lateral reduction at the P2 level. Clinical experience is limited to a temporary implant in two patients, in whom the device appeared safe and effective.40 The Myocor i-Coapsys (Edwards Lifesciences, Inc., Irvine, CA) is the percutaneous version of the surgical Coapsys, a surgical device to reshape the left ventricle. Large-scale data from the surgical RESTOR-MV trial suggest that, besides the MR reduction, the Coapsys can produce a significant LV restoration effect,41 also reducing myocardial fiber stress.