One-Year Outcomes After Transapical Echocardiography-Guided Mitral Valve Repair

Colli, Andrea; Manzan, Erica; Besola, Laura; Bizzotto, Eleonora; Fiocco, Alessandro; Zucchetta, Fabio; Bagozzi, Lorenzo; Bellù, Roberto; Denas, Gentian; Pittarello, Demetrio; Gerosa, Gino

doi:10.1161/circulationaha.118.033509

Cited by 38 publications

(33 citation statements)

References 5 publications

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“…Thus, our initial results show safety and technique feasibility as well as the potential for restoration of the proper mitral valve function in selected patients. More follow-up data are needed in order to optimally select patients for the potential of a durable result [26].…”

Section: Discussionmentioning

confidence: 99%

Transapical beating heart mitral valve repair with the NeoChord system: early outcomes of a single-center experience

Wróbel¹,

Kurnicka²,

Zygier³

et al. 2019

wiitm

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Introduction: Trans-apical beating heart off-pump mitral valve (MV) repair is a novel surgical technique for treating mitral regurgitation (MR) caused by degenerative flail/prolapse (DLP). Aim: To present early outcomes of a single-center experience with transapical beating heart mitral valve repair with the NeoChord system. Material and methods: Thirty-seven patients with severe symptomatic MR were treated with the NeoChord technique between September 2015 and December 2018 (78% men; mean age: 62.3 ±13.4 years). We evaluated standard cardiac surgery perioperative complications as well as those related to the NeoChord technique as well as early surgical success as defined by the reduction of MR to less than moderate by implantation of at least 2 neochordae. Results: During this series we had no hemodynamic instability due to bleeding or arrhythmia. There were no transapical technique-related adverse events such as a leaflet perforation or tear, a major native chord rupture, which would require implantation of a new chord, ventricular apex rupture, or left atrial perforation. There were no major adverse events including death, stroke or acute myocardial infarction. Nine (24%) patients developed an episode of perioperative atrial fibrillation. We were able to conclude the operation in 98% of our patients with less than moderate MR. One (2%) patient had moderate MR at the conclusion of the operation. Conclusions: Trans-apical off-pump MV repair with the NeoChord system is a safe, minimally invasive procedure, with few minor complications. In well-selected candidates it provides successful treatment of degenerative MR. Results are anatomy dependent, so preoperative patient selection is crucial.

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Section: Discussionmentioning

confidence: 99%

Transapical beating heart mitral valve repair with the NeoChord system: early outcomes of a single-center experience

Wróbel¹,

Kurnicka²,

Zygier³

et al. 2019

wiitm

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“…Finally, we have observed that MV morphology is a consideration affecting residual mitral regurgitation. As with conventional surgical MVr, patients presenting with isolated central posterior leaflet prolapse or flail (type A morphology), as well as posterior multi-segment involvement (type B), demonstrate better outcomes than those patients with more complex MV lesions, such as anterior leaflet (type C) and paracommissural or calcified leaflets (type D) (13,14,22,23). In our practice, patient selection criteria for MVr with the NeoChord procedure are well established and approximately 25-30% of patients presenting with degenerative mitral disease can be safely and effectively treated with the NeoChord procedure.…”

Section: Commentsmentioning

confidence: 99%

Transapical NeoChord mitral valve repair

Colli

Adams

Fiocco

et al. 2018

Ann. Cardiothorac. Surg.

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Transapical off-pump mitral valve repair (MVr) with NeoChord implantation has become widely applied in Europe for patients presenting with severe mitral regurgitation due to leaflet prolapse or flail. The procedure is performed under real-time 2D-and 3D-transesophageal echocardiography (TEE) for both implantation and neochordae tension adjustment allowing real-time monitoring of hemodynamic recovery. Preoperative anatomic and echocardiographic selection criteria, procedure refinement, as well as innovative ex-vivo surgical simulator training have been developed and strategically employed in the past few years, to generate a robust precision-based procedural framework with significantly enhanced operator use, patient safety and clinical outcomes. The procedure has evolved into a reproducibly successful and safe approach, which complements existing surgical treatment strategies available to eligible patients with chronic severe degenerative mitral regurgitation.

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“…Multiple reports have demonstrated the safety and feasibility of transapical MV repair using the Neo-Chord DS1000 device with an effective reduction of MR achieved during the procedure [8,13]. Colli et al recently published procedural outcomes and 12-month follow-up data of the largest series at a single institution [14], followed by a manuscript presenting multicenter European experience [8]. Reported intraoperative results are quite similar to those presented in this study: two thirds of the patients received three or four artificial chordae, rates of conversion to conventional surgery and mortality were 1.4-1.9% vs. 1.3% in this series.…”

Section: Discussionmentioning

confidence: 99%

Comparison of early postoperative results between conventional and transapical mitral valve repair

Zorinas¹,

Lipnevičius²,

Bleizgytė³

et al. 2019

pwki

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Introduction: Conventional mitral valve repair (CMVR) is well-established, safe and effective treatment for degenerative mitral regurgitation (MR). Transapical off-pump implantation of artificial chordae (TA) has been introduced into practice and gained interest among surgeons. However, there are no publications comparing the results between TA and CMVR. Aim: To compare early postoperative outcomes of CMVR with TA in patients with degenerative MR. Material and methods: This was a retrospective cohort study. A total of 169 patients who underwent mitral valve repair between 2011 and 2018 were included in this analysis. Patients were divided into two groups: the TA group, n = 78 and CMVR group, n = 91. The groups were compared for early postoperative outcomes. Results: Patients in the TA group were younger, 54.2 ±11.1 vs. 59.5 ±12.8 years (p = 0.005). Patients in the CMVR group had more complicated postoperative course with higher incidence of blood transfusion (42.9% vs. 7.8%, p = 0.001), atrial fibrillation (25.3% vs. 11.7%, p = 0.031), renal insufficiency (15.4% vs. 2.6%, p = 0.007) and stroke (2.1% vs. 0%). In the early postoperative period, one patient died in the TA group, and there were no deaths in the CMVR group (p = 0.277). Residual moderate to severe mitral regurgitation was present in nine (11.5%) TA patients, while none of the patients in the CMVR group had moderate or a higher degree of residual regurgitation (p = 0.001). Conclusions: Off-pump transapical MV repair is a feasible and safe procedure with low postoperative morbidity rates. Higher rates of mitral regurgitation reoccurrence would require a careful and thorough selection of the patients suitable for the TA approach.

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One-Year Outcomes After Transapical Echocardiography-Guided Mitral Valve Repair

Cited by 38 publications

References 5 publications

Transapical beating heart mitral valve repair with the NeoChord system: early outcomes of a single-center experience

Transapical beating heart mitral valve repair with the NeoChord system: early outcomes of a single-center experience

Transapical NeoChord mitral valve repair

Comparison of early postoperative results between conventional and transapical mitral valve repair

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