Transcatheter mitral valve chord repair

Abstract

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.

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

“…Although transapical neochordae implantation has been demonstrated to be safe and effective in patients with primary MR, this is still a technically demanding technology in the early stage of use. A number of issues such as residual leaflet prolapse when treating multi‐scallop disease, determination of the optimal suture number, placement and length, and proper patient selection to ensure a safe and durable repair remain to be studied in detail …”

Percutaneous Treatment of Mitral Valve Regurgitation: An Evolving Field

“…Various devices have been created and prospective clinical trials are ongoing. Results show these procedures are safe, with minimal morbidity and mortality, an important reduction in MR and left ventricular reverse remodelling is obtained [24,25]. However, patient selection, once more, seems the critical issue: such devices provide focal support where the loop is implanted, resulting in un-even coaptation along the prolapsing segment.…”

Computer simulations of transapical mitral valve repair with neochordae implantation: Clinical implications

“…2 After the success of transcatheter aortic valve (AV) replacement in treating aortic stenosis, great effort has been made in recent years toward the development of minimally invasive technologies for MV repair. In particular, transapical beating heart implantation of expanded polytetrafluoroethylene (ePTFE) sutures (ie, neochordae) has demonstrated potential effectiveness and safety in treating a subset of patients with primary MR. 3 Transapical neochordae implantation is an emerging technology with several medical devices being actively developed and limited experience in humans. Some aspects of this technique, such as determining the optimal left ventricular (LV) apical access site, ideal neochordae number, length, and leaflet placement, have not been fully standardized and can only be assumed at the moment.…”