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

Abstract

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.

Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes

“…One advantage of the NeoChord procedure compared to technologies such as the MitraClip which create a fixed coaptation point, is that it does not create any barriers to MV re-repair if necessary, making it more appealing for early-stage disease treatment in younger patients. In our study, four (30%) of the patients who required reintervention were re-repaired rather than requiring MV replacement confirming what shown by other groups (16). Moreover, two out of four were re-repaired through re-NeoChord procedure.…”

Transapical off‐pump mitral valve repair with NeoChord implantation: A systematic review

“…Colli et al 11 Overlap of included patients with Colli et al 12 Colli et al 13 Overlap of included patients with Colli et al 12 Colli et al 14 Overlap of included patients with Colli et al 12 Colli et al 15 Overlap of included patients with Colli et al 12 Colli et al 16 Overlap of included patients with Colli et al 12 Colli et al 17 Overlap of included patients with Colli et al 12 Kurnicka et al 6 Overlap of included patients with Colli et al 12 Rucinskas et al 18 Overlap of included patients with Colli et al 12 Samalavicius et al 19 Overlap of included patients with Colli et al 12 Wrobel et al 7 Overlap of included patients with Colli et al 12 Seeburger et al 20 Overlap of included patients with Colli et al 12 and Kiefer et al 21 Kavakli et al 22 Overlap of included patients with Kavakli et al 23…”

“…It has gained increasing recognition as a feasible, safe, and effective procedure with minor complications and excellent outcome. 6,7 While the device is approved for clinical use in European countries, it is not yet approved in the United States. Currently, there are two ongoing studies evaluating the performance of the procedure in Germany (ClinicalTrials.gov identifier: NCT04190602) and in the United States (ClinicalTrials.gov identifier: NCT02803957) with expected completion dates at 2027 and 2025, respectively.…”

“…The latter technique entails the implantation of artificial chordae on a beating heart under transesophageal echocardiographic guidance. It has gained increasing recognition as a feasible, safe, and effective procedure with minor complications and excellent outcome 6,7 . While the device is approved for clinical use in European countries, it is not yet approved in the United States.…”