Prognostic impact of leaflet-to-annulus index in patients treated with transapical off-pump echo-guided mitral valve repair with NeoChord implantation

Colli, Andrea; Besola, Laura; Montagner, Matteo; Azzolina, Danila; Soriani, Nicola; Manzan, Erica; Bizzotto, Eleonora; Zucchetta, Fabio; Bellù, Roberto; Pittarello, Demetrio; Gerosa, Gino

doi:10.1016/j.ijcard.2018.01.049

Cited by 45 publications

(42 citation statements)

References 14 publications

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“…MVr with the NeoChord procedure has been shown to provide incremental benefit for the acute volumetric reduction of the left ventricle and atrium in this patient population, followed by the concomitant improvement in MV geometry immediately following trans-apical replacement of ruptured or elongated chordae with the NeoChord technology. These observations have been sustained in late follow-up periods (17)(18)(19).…”

Section: Commentsmentioning

confidence: 74%

“…In addition, in our series of patients, we have observed that the leaflet-to-annulus index (LAI) is helpful in predicting the amount of leaflet tissue that will yield post- procedure coaptation and significantly correlates with at most mild residual mitral regurgitation at one-year followup when the LAI is >1.2 (17). As recently reported, patients with a lower LAI (1.1 to 1.2) presenting with isolated central (P2) segment disease, might also undergo a successful MVr with the NeoChord procedure when associated with more anterior ventricular access (19)(20)(21). Ventricular access which is more anterior will modify the working angle of the posterior leaflet, stretching it below the anterior leaflet, and thereby increasing the potential leaflet coaptation.…”

Section: Commentsmentioning

confidence: 98%

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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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Section: Commentsmentioning

confidence: 74%

Section: Commentsmentioning

confidence: 98%

Transapical NeoChord mitral valve repair

Colli

Adams

Fiocco

et al. 2018

Ann. Cardiothorac. Surg.

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“…The central echocardiographic selection criteria became the leaflet-to-annulus index (LAI) (14) that evaluate the leaflet to annulus mismatch. LAI is calculated as the ratio between the sum of anterior and posterior leaflet height and the antero-posterior diameter and represents the amount of overriding tissue that could generate the leaflet coaptation surface.…”

Section: Neochordmentioning

confidence: 99%

Transcatheter Mitral Valve Chordal Repair: Current Indications and Future Perspectives

Fiocco

Nadali

Speziali

et al. 2019

Front. Cardiovasc. Med.

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Transcatheter Mitral Valve Repair (TMVRe) technologies constitute a rapidly expanding field, and have the potential of being adopted as a valuable alternative to surgery in selected patients. TMVRe devices can be distinguished depending on the targeted part of the Mitral Valve (MV) apparatus. Standard classification includes leaflet repair, direct/indirect annuloplasty, chordal repair, and ventricular/chamber remodeling devices. We present the current device situation on chordal repair technologies. Nowadays, transapical off-pump beating heart chordal implantation procedure has become a safe and reproducible option for Degenerative Mitral Regurgitation (DMR). Besides the truly minimally-invasiveness of the procedure, another unique advantage offered by a beating-heart chordal implantation is the real-time assessment of chordal length adjustment during heart cycle with a normally filled left ventricle. Currently, one system is commercially available in Europe, the NeoChord DS 1000 (NeoChord, Inc., St. Louis Park, MN) and the Harpoon TDS-5 (Edwards Lifesciences, Irvine, CA) should become available soon. There is also a diffuse and strong interest to move from a transapical procedure toward a fully transcatheter (transfemoral and transeptal) procedure as shown by the increased number of preclinical programs under development. Interestingly, to achieve outcomes that equate to those of open surgery in DMR, transcatheter therapies will need to follow rigid indications due to strict patient selection criteria for each device, or adopt multiple techniques in a single repair procedure for complex MV disease. Continuous analysis of current clinical results together with future dedicated trial will be of extreme importance to foster the new and upcoming field of transcatheter MV therapy technology development.

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“…The Leaflet-to-Annulus Index (LAI) <1.4, defined as the ratio between the sum of anterior leaflet length and posterior leaflet length over antero-posterior length, can be used as reliable predictor to identify patients without annular dilatation (32,33). The LAI identifies the quantity of overlapping leaflet tissue that will represent the potential coaptation surface after the correction (Figure 7).…”

Section: Role Of Concomitant Annuloplasty To Artificial Chordaementioning

confidence: 99%

Transcatheter mitral valve chord repair

Savić

Pozzoli

Gülmez

et al. 2018

Ann. Cardiothorac. Surg.

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The field of mitral valve disease diagnosis and management is rapidly evolving. New understanding of pathophysiology and improvements in the adoption of sophisticated multimodality imaging modalities have led to early diagnosis and to more complex treatment. The most common cause of mitral regurgitation (MR) in the western world is in the primary alteration of the valve, which leads to degenerative leaflet prolapse due to chordal elongation or rupture and annular dilatation. Untreated, significant MR has a negative impact prognosis, leading to reduction of survival. In the setting of degenerative MR, surgical repair currently represents the standard of care. Treatment of asymptomatic patients with severe MR in the Valve Center of Excellence, in which successful repair reaches more than 95% and surgical mortality less than 1%, symbolizes the direction for the next years. Transcatheter mitral valve repair with different devices, more recently the chordal replacement ones, is providing good outcomes and became a therapeutic option in highrisk patients with degenerative MR. In the future, more advances are expected from further development of interventional techniques, careful evaluation and better patient selection. This review will focus on long-term surgical outcomes of mitral valve repair with artificial chordae and on the emerging transcatheter chordal repair devices as therapeutic options for degenerative MR patients.

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Prognostic impact of leaflet-to-annulus index in patients treated with transapical off-pump echo-guided mitral valve repair with NeoChord implantation

Cited by 45 publications

References 14 publications

Transapical NeoChord mitral valve repair

Transapical NeoChord mitral valve repair

Transcatheter Mitral Valve Chordal Repair: Current Indications and Future Perspectives

Transcatheter mitral valve chord repair

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