Background. Transapical, beating heart, off-pump implantation of neochordae for repair of mitral valve (MV) prolapse is of increasing interest. The aim of this study was to evaluate long term results for MV repair using the NeoChord system (NeoChord, St. Louis Park, MN).Methods. Six patients underwent treatment for severe primary mitral regurgitation (MR) with the NeoChord DS1000 system as part of the initial device safety and feasibility Transapical Artificial Chordae Tendinae (TACT) trial at our institution

Patients with BAV have a distinctive dissection pattern with the entry tear frequently located in the aortic root and-despite their younger age-are subject to substantial hospital mortality. For bicuspid patients suffering from dissection, composite root replacement yields an excellent outcome equal to an age- and gender-matched normal population.

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These experiments confirm that the paraspinous vasculature in the presented large animal model is directly linked to spinal cord microcirculation and that the regional paraspinous muscle oxygenation status reflects spinal cord tissue oxygenation. As lumbar cnNIRS reproducibly depicts tissue oxygenation of the paraspinous vasculature, it can be used for non-invasive spinal cord oxygenation monitoring in real-time.

Objective Paraplegia remains the most devastating complication after thoracic and thoracoabdominal aortic aneurysm (TAA/A) repair. The collateral network (CN) concept of spinal cord perfusion suggests segmental artery (SA) occlusion to mobilize redundant intraspinal and paraspinal arterial sources and ultimately trigger arteriogenesis, leading to spinal cord blood flow restoration within 96 to 120 hours. This principle is used by the two-staged approach to TAA/A-repair—which has lead to an elimination of paraplegia in an experimental model. However, the clinical implementation of a two-staged surgical procedure is challenging, particularly in the absence of an appropriate vascular segment for a “staged” open anastomosis or an appropriate endovascular landing zone. Selective, transfemoral minimally invasive SA coil embolization (MISACE) could provide the solution for one-stage repair of extensive aortic pathologies by triggering arteriogenic CN preconditioning and thereby allowing for recruitment of otherwise redundant arterial collaterals to the spinal cord. Methods The feasibility of MISACE was explored in a single animal using an established piglet model. A 6F sheet was introduced via the femoral artery, and a 4F standard Judkins catheter was used for selective angiography and coil insertion. All thoracic and lumbar aortic SAs (15 pairs; Th4–L5) were successfully identified by dye injection. Pediatric platinum endovascular coils (Trufill Pushable Coils, 3 × 20 mm; Cordis, Waterloo, Belgium) were deployed to serially occlude the SA mimicking a CN preconditioning procedure. Results All intercostal (thoracic) and lumbar aortic SAs (Th4–L5) were successfully identified and occluded by coil embolization. Successful SA coil embolization was verified intraoperatively by selective dye injection on angiography. No intraoperative coil dislodgement occurred. Autopsy revealed complete occlusion of all embolized SAs enhanced by early local thrombus formation. Thrombotic material was found only distally to the coils. No SA dissection was observed at the aortic SA origins. Conclusions The MIS ACE technique allows for rapid serial endovascular occlusion of all thoracic and lumbar SAs. This new innovative approach bares the potential to CN preconditioning at the respective level of aortic pathology—to allow for adequate perioperative spinal cord blood supply—before conventional open or endovascular surgery. Selective, transarterial MISACE might lead to a dramatic reduction of ischemic spinal cord injury after open and endovascular TAA/A repair in the future.