Learning curve analysis of transapical NeoChord mitral valve repair†

Abstract

NeoChord repair is a safe procedure, and the results are maintained through the 1-year follow-up. A relative high number of implants were required to overcome the learning curve at our institution due to the concurrent development of patient selection criteria and the technical refinement of the procedure. Future studies are needed to assess the evolution of the learning curve after the wide adoption of the procedure across European and North American centres.

Transapical NeoChord mitral valve repair

“…To date, the NeoChord procedure has been successfully performed in over 1,000 patients in Europe and the USA respectively (unpublished data). Since its first application (10), the NeoChord technology has demonstrated excellent outcomes in reducing mitral regurgitation in eligible patients with chronic severe degenerative mitral regurgitation (4,(11)(12)(13)(14). In the United States, the NeoChord technology has received investigational device exemption (IDE) approval from the United States Food and Drug Administration (FDA) and subjects are being enrolled in a prospective, multicenter, randomized controlled clinical trial comparing the NeoChord procedure with conventional surgical MV repair (ClinicalTrials.gov NCT02803957).…”

“…This demonstrates a relatively short learning curve required to achieve expertise in performing the NeoChord procedure safely and successfully. These rates, nonetheless, are still subject to continuous improvement mainly due to ongoing procedural improvements and standardization (12,17). Currently and despite the disciplined selection process based on clear inclusion and exclusion criteria, there is little equipoise in the definition of the ideal candidate for the NeoChord procedure.…”

When Culture Dictates Practice: Adoption of Minimally Invasive Mitral Valve Surgery

“…9,22 Similar experiences have been observed with both MitraClip and NeoChord approaches. 23,24 Based on these numbers and average mitral cases per year per center and per surgeon, there is a substantial and understandable barrier toward adopting minimally invasive approaches in one's surgical skillset for low volume centers and surgeons. Along these lines, surgeons who performed minimally invasive mitral valve surgery reported having significantly higher annual mitral volume compared with cardiac surgeons performing sternotomy only.…”

Transcatheter Mitral Valve Chordal Repair: Current Indications and Future Perspectives

“…The combination of procedure standardization, technical refinements, and understanding of selection criteria has been analyzed in a single center experience requiring almost 50 procedures as shown by the CUSUM analysis performed (16). Operators had to acquire new surgical skills as well as new visualization training passing from the usual direct surgical view to an echocardiographic real time guidance (17).…”