“The Starry Sky.” A new intraprocedural three‐dimensional echocardiographic technique

Vairo, Alessandro; Marro, Matteo; Speziali, Giovanni; Rinaldi, Mauro

doi:10.1111/echo.14474

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…The use of three-dimensional (3D) TEE is already described as a fundamental tool to direct this beating-heart repair in terms of chordal implantation position and morphological analysis of the MV during and after neochordae traction and fixation. 5,6 Careful analysis of the morphological details of the LV chamber, in particular the anatomy of subvalvular apparatus and papillary muscle (PM) insertion, is important to plan the device navigation and choose the best access site. This is one of the most significant steps for procedural success and safety.…”

Section: Central Messagementioning

confidence: 99%

Three-Dimensional Finger Test: A New Echocardiographic Method to Locate the Best Access Site During NeoChord Procedure

Vairo

Manaï

Gaiero

et al. 2023

Innovations�(Phila)

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Objective: Transventricular beating-heart mitral valve repair (TBMVR) with artificial chordae implantation is a technique to treat mitral valve prolapse. Two-dimensional (2D) echocardiography completed with simultaneous biplane view during surgeon finger pushing on the left ventricular (LV) wall (finger test [FT]) is currently used to localize the desired LV access, on the inferior-lateral wall, between the papillary muscles (PMs). We aimed to compare a new three-dimensional (3D) method with conventional FT in terms of safety and better localization of LV access. Methods: During TBMVR, conventional FT was completed using 3D transesophageal echocardiography by placing the sample box in the bicommissural view of the LV, including the PMs and the apex. The 3D volume was subsequently edited to visualize the LV from above (surgical view) to localize the bulge of the operator’s finger pushing on the LV. We asked the first operator, the second operator, and the cardiac surgery fellow, separately, to evaluate the location of their finger pushing, both with the 2D method and the 3D method, to estimate the interoperator concordance. Results: From 2019 to 2021, 42 TBMVRs were performed without complications related to access using FT completed with the 3D method. Regarding the choice of the right and safe entry site, the operator’s agreement was higher using 3D rendering compared with conventional FT (mean agreement 0.59 ± 0.29 for 2D vs 0.83 ± 0.20 for 3D), while full operator agreement was 10 of 42 for 2D and 23 of 42 for 3D ( P = 0.004). Conclusions: Three-dimensional FT is easy to perform and facilitates surgeons choosing the best access for TBMVR in term of anatomical localization and safety.

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Section: Central Messagementioning

confidence: 99%

Three-Dimensional Finger Test: A New Echocardiographic Method to Locate the Best Access Site During NeoChord Procedure

Vairo

Manaï

Gaiero

et al. 2023

Innovations�(Phila)

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“…The efficacy and safety of this solution have already been demonstrated mainly thanks to the worldwide expansion of the Neochord experience. The market launch of this new device, as the development of many others under preclinical investigation, 7,[27][28][29][30][31][32] demonstrates, if there was still a need, the importance of a novel and alternative approach in mitral valve disease treatment. Artificial chordal implantation is an already validated technique in mitral valve surgery with proven results in acute and long-term outcomes, 33,34 usually associated with prosthetic ring annuloplasty.…”

mentioning

confidence: 99%

“…Trying to replicate surgery results, avoiding CPB and cardioplegic arrest, is ambitious, but it is worth the effort. Pursuing this aim, many studies have been published to optimize the Neochord procedure and the patients' selection, 7,[27][28][29][30][31][32] paving the road to better results for all the new devices entering the clinical arena. Therefore, the good short-term outcomes reported by Wang et al are not surprising and could potentially be confirmed at mid-and long-term follow-up.…”

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confidence: 99%

Actual perspective on off‐pump transapical artificial chord implantation

Saccocci

Colli

2022

Journal of Cardiac Surgery

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Mitral valve repair (MVR) is undisputedly associated with better clinical and functional outcomes than any other type of valve substitute. Conventional mitral valve surgery in dedicated high-volume centers can assure excellent results in terms of mortality and freedom from mitral regurgitation (MR) recurrence but requires cardiopulmonary bypass (CPB) and cardioplegic heart arrest. Trying to replicate the percentage of success of surgical MVR is the aim of all new transcatheter mitral dedicated devices. In particular, transapical beating-heart mitral valve repair by artificial chordae implantation with transesophageal echocardiography guidance is an expanding field. The safety and feasibility of the procedure have already been largely demonstrated with Neochord and more recently with Harpoon systems. Wang et al. present the outcomes of the first-in-human experience using a novel artificial chordae implantation device, the Mitralstitch system.Despite a quite small cohort of only 10 patients treated, 1-year results are satisfying and comparable with the early experience with former devices (4 patients with moderate or more MR recurrence). The comparison with surgical MVR is still unfavorable and requires further studies and significant procedure improvement. However, the device permits the treatment of anterior and posterior leaflets prolapse and performs quite easily edge-toedge reparation. It will be interesting to evaluate longer follow-up in larger cohorts of patients as well as the possibility to shift to the transfemoral approach.

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New Echocardiographic Parameters Predicting Successful Trans-Ventricular Beating-Heart Mitral Valve Repair with Neochordae at 3 Years: Monocentric Retrospective Study

Vairo

Gaiero

Marro

et al. 2023

JCM

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The NeoChord procedure is an echo-guided trans-ventricular beating-heart mitral valve repair technique to treat degenerative mitral regurgitation (MR) due to prolapse and/or flail. The aim of this study is to analyze echocardiographic images to find pre-operative parameters to predict procedural success (≤moderate MR) at 3-year follow-up. Seventy-two consecutive patients with severe MR underwent the NeoChord procedure between 2015 and 2021. MV pre-operative morphological parameters were assessed using 3D transesophageal echocardiography with dedicated software (QLAB, Philips). Three patients died during their hospitalization. The remaining 69 patients were retrospectively analyzed. At follow-up, MR > moderate was found in 17 patients (24.6%). In the univariate analysis, end-systolic annulus area (12.5 ± 2.5 vs. 14.1 ± 2.6 cm2; p = 0.038), end-systolic annulus circumference (13.2 ± 1.2 vs. 14 ± 1.3 cm; p = 0.042), indexed left atrial volume (59 ± 17 vs. 76 ± 7 mL/m2; p = 0.041), and AF (25% vs. 53%; p = 0.042) were lower in the 52 patients with ≤ MR compared to those with > moderate MR. Annular dysfunction parameters were the best predictors of procedural success: 3D early-systolic annulus area (AUC 0.74; p = 0.004), 3D early-systolic annulus circumference (AUC 0.75; p = 0.003), and 3D annulus area fractional change (AUC 0.73; p = 0.035). Patient selection relying on 3D dynamic and static MA dimensions may improve the maintenance of procedural success at follow-up.

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“The Starry Sky.” A new intraprocedural three‐dimensional echocardiographic technique

Cited by 3 publications

References 5 publications

Three-Dimensional Finger Test: A New Echocardiographic Method to Locate the Best Access Site During NeoChord Procedure

Three-Dimensional Finger Test: A New Echocardiographic Method to Locate the Best Access Site During NeoChord Procedure

Actual perspective on off‐pump transapical artificial chord implantation

New Echocardiographic Parameters Predicting Successful Trans-Ventricular Beating-Heart Mitral Valve Repair with Neochordae at 3 Years: Monocentric Retrospective Study

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