Transapical NeoChord mitral valve repair

Colli, Andrea; Adams, David H.; Fiocco, Alessandro; Pradegan, Nicola; Longinotti, L; Nadali, Matteo; Pandis, Dimosthenis; Gerosa, Gino

doi:10.21037/acs.2018.11.04

Cited by 61 publications

(49 citation statements)

References 24 publications

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“…There were 4 patients with type B and 4 patients with type C MR in our series. The rate of re-intervention for trans-apical neochord failure during the follow-up period was (3/24, 12.5%) higher than the value reported by Colli et al (22) (4/49, 8.2%). This may be because the number of type B and C patients in our study were higher than the patients in their study (8/26, 5/49 respectively) (22).…”

Section: Discussioncontrasting

confidence: 59%

Is transapical off-pump neochord implantation a safe and effective procedure for mitral valve repair?

et al. 2019

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Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair? Objective: Trans-apical off-pump mitral valve repair is a new minimally invasive surgical technique for the correction of mitral regurgitation caused by mitral leaflet prolapse. The purpose of this study is to evaluate, using clinical and echocardiographic follow-up data, the mid-term results of patients undergoing this procedure. Methods: A total of 26 patients diagnosed with severe mitral regurgitation underwent mitral valve repair with trans-apical off-pump neochord implantation using the NeoChord device at our hospital from July 2015 to July 2017. All patients were examined by transthoracic and transesophageal echocardiography. Eighteen (69.2%) patients had type A anatomy, 4 (15.4%) had type B anatomy, and 4 (15.4%) had type C anatomy. Preoperative, intraoperative, and postoperative demographic, echocardiographic, and clinical data were collected. Results: The patients' age ranged from 33 to 76 years (mean: 56±10.1 years). The average preoperative EuroSCORE II was 1.04%±0.7%. Acute procedural success was achieved in 25 (96.15%) patients. There was only 1 early death (30-day mortality rate: 3.8%) due to postoperative low cardiac output syndrome. Transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation in 87.5% of the patients and moderate regurgitation in 12.5% of the patients. During the follow-up period, transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation (MR) in 14 (58.3%) patients. Six (25%) patients presented with moderate MR and 4 (16.7%) patients had severe MR. At the 30-month follow-up, freedom from residual severe MR was 78.8%±10.3% and freedom from reoperation was 87.5%±6.8%. Conclusion: Trans-apical off-pump mitral valve repair with neochord implantation may be a suitable treatment option in patients with isolated posterior mitral valve leaflet prolapse.

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Section: Discussioncontrasting

confidence: 59%

Is transapical off-pump neochord implantation a safe and effective procedure for mitral valve repair?

et al. 2019

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“…27,28 In this study, virtual transapical neochordae repair was modeled under optimal implantation conditions, that is, following the manufacturer's recommendations 29 and the clinical step-by-step guide. 26,30 Clinically, three or four neochordae are implanted on average in order to balance the tension per neochorda, provide structural support, and avoid excessive mechanical stress on the leaflets. 4 Thus, three (NC3) and four (NC4) neochordae were modeled in this study for each PML prolapse model, as seen in Figure 1B.…”

Section: Transapical Neochordae Modelingmentioning

confidence: 99%

Transapical mitral valve repair with neochordae implantation: FSI analysis of neochordae number and complexity of leaflet prolapse

Caballero

Mao

McKay

et al. 2019

Numer Methods Biomed Eng

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Transapical mitral valve repair with neochordae implantation is a relatively new minimally invasive technique to treat primary mitral regurgitation. Quantifying the complex biomechanical interaction and interdependence between the left heart structures and the neochordae during this procedure is technically challenging. The aim of this parametric computational study is to investigate the immediate effects of neochordae number and complexity of leaflet prolapse on restoring physiologic left heart dynamics after optimal transapical neochordae repair procedures. Neochordae implantation using three and four sutures was modeled under three clinically relevant prolapse conditions: isolated P2, multi‐scallop P2/P3, and multi‐scallop P2/P1. A fluid‐structure interaction (FSI) modeling framework was used to evaluate the left heart dynamics under baseline, prerepair, and postrepair states. Despite immediate restoration of leaflet coaptation and no residual mitral regurgitation in all postrepair models, the average and peak stresses in the repaired scallop(s) increased >40% and >100%, respectively, compared with the baseline state. Additionally, anterior mitral leaflet marginal chordae tension increased >30%, while posterior mitral leaflet chordae tension decreased at least 30%. No marked differences in hemodynamic performance, in native and neochordae forces, and in leaflet stress were found when implanting three or four sutures. We report, to our knowledge, the first set of time‐dependent in silico FSI human neochordae tension measurements during transapical neochordae repair. This work represents a further step towards an improved understanding of the biomechanical outcomes of minimally invasive mitral valve repair procedures.

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“…Since the introduction of the technology, more than 1000 patients in Europe and the USA have successfully undergone the NeoChord procedure [9]. This system allows minimally invasive off-pump delivery of the ePTFE chordae to the prolapsing or flail MV leaflet and enables the adjustment of the length of the chordae under direct echocardiographic control while the valve is fully functioning under physiologic conditions of the beating heart.…”

Section: Discussionmentioning

confidence: 99%

“…This system allows minimally invasive off-pump delivery of the ePTFE chordae to the prolapsing or flail MV leaflet and enables the adjustment of the length of the chordae under direct echocardiographic control while the valve is fully functioning under physiologic conditions of the beating heart. This TEE guided procedure is currently standardized and is described in detail in recent publications of Colli et al [5,9] and Samalavicius et al [10].…”

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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Transapical NeoChord mitral valve repair

Cited by 61 publications

References 24 publications

Is transapical off-pump neochord implantation a safe and effective procedure for mitral valve repair?

Is transapical off-pump neochord implantation a safe and effective procedure for mitral valve repair?

Transapical mitral valve repair with neochordae implantation: FSI analysis of neochordae number and complexity of leaflet prolapse

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

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