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Despite the success of current medical and surgical management of ischemic heart disease, a growing number of patients have diffuse obstructive coronary artery disease that is not amenable to coronary-artery bypass grafting or catheter-based interventions. This problem has stimulated interest in developing alternative therapeutic approaches. Early attempts at indirect myocardial revascularization had limited success. Beck's use of omentopexy, reported in 1935, 1 and Vinberg's use of thoracic-artery implantation, reported in 1954, 2 were attempts to provide direct myocardial perfusion and were based on the description by Wearn et al., in 1933, 3 of a sinusoidal network in the human heart. In 1965, Sen . . .

This study compared a percutaneous, catheter-based method, in which a clip is placed to approximate the edges of the two mitral-valve leaflets, with conventional surgery. The procedure obviated the need for open-heart surgery in 80% of the patients who received it. Severe mitral regurgitation is associated with progressive left ventricular dysfunction and congestive heart failure. 1 Without intervention, symptomatic patients have an annual rate of death of 5% or more. 1 – 3 Medical management alleviates symptoms but does not alter the progression of the disease. 2 Current guidelines recommend surgery for moderate-to-severe (grade 3+) or severe (4+) mitral regurgitation in patients with symptoms or evidence of left ventricular dysfunction. 4 – 6 One surgical approach for mitral-valve repair involves approximation of the mitral leaflets with suture to create a double orifice. 7 – 9 This procedure has been described for treatment of degenerative mitral regurgitation and is usually . . .