Transventricular off-pump anterior mitral leaflet augmentation: First in human

Salizzoni, Stefano; Marro, Matteo; Vairo, Alessandro; Marra, Walter Grosso; Speziali, Giovanni

doi:10.1016/j.jtcvs.2019.02.027

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…For example, transcatheter technologies that target treatment of the mitral annulus and/or mitral leaflets can be applied as a complementary therapeutic approach in a staged or sequenced manner along with the NeoChord procedure to expand beating heart treatment options for patients who present leaflet-to-annulus mismatch caused by excessive annular dilatation (18,19). Another interesting concept recently shown is the use of the NeoChord device as a flexible platform to perform chordal-based edge-to-edge repair or leaflet augmentation combining chords and pericardial patch as in traditional complex open-heart surgery (20,21). Currently, we estimate by default that approximately 15% to 20% of patients with diagnosed degenerative MV disease meet the anatomical criteria for the NeoChord procedure.…”

Section: Discussionmentioning

confidence: 99%

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

Gerosa

Nadali

Longinotti

et al. 2021

Ann Cardiothorac Surg

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Background: The NeoChord echo-guided transapical beating heart repair is a promising early-stage minimally invasive surgical procedure for degenerative mitral valve (MV) regurgitation (DMR) correction. The technique has been improved since its inception following procedure standardization, patient selection optimization, and learning curve stabilization. We hereby present the mid-term clinical results through three years of our large single center experience. Methods: All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both mitral leaflets that underwent the NeoChord procedure between November 2013 and June 2019 were included. Patients were categorized according to MV anatomy; Type A isolated central posterior leaflet prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular calcifications. Patients underwent clinical and echocardiographic follow-up at one, three, six, twelve months and yearly thereafter. Clinical outcomes and the composite primary endpoint (patient success) were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria. Mitral regurgitation (MR) severity was graded as absent, mild, moderate and severe according to American Society of Echocardiography (ASE) and European Society of Cardiology (ESC) guidelines. Results: Two hundred and three patients were included; median follow-up was 24 months [interquartile range (IQR), 9-36]. Median age was 64 years (IQR, 54-74 years), median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) was 0.60% (IQR, 0.32-1.44%). There were 106 Type A patients (52.2%), 68 Type B (33.5%), 16 Type C (7.9%), and 13 Type D (6.4%). Kaplan-Meier estimate of survival was 99.0%±0.7% at one and two years and 94.0%±2.9% at three years. At one-year follow-up patient success was 91.2%±2.0% and 111 patients (74%) presented a residual MR mild or less (1+). At three-year follow-up patient success was 81.2%±3.8% and 32 patients (64%) had a residual MR mild or less (1+). Patient success was significantly different according to anatomical type (P=0.001). Echocardiographic analysis showed a significant acute left ventricle and left atrial reverse remodeling that was maintained up to three years. Conclusions: The NeoChord echo-guided transapical beating heart repair procedure demonstrated good clinical outcomes and echocardiographic results up to three-year follow-up.

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Section: Discussionmentioning

confidence: 99%

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

Gerosa

Nadali

Longinotti

et al. 2021

Ann Cardiothorac Surg

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“…Recently, the NeoChord DS1000 has been used to treat focal A2 segmental prolapse on the anterior leaflet. 15…”

Section: Cherish Thine Echocardiographer!mentioning

confidence: 99%

Finding the Future: The 10 Commandments of Beating Heart Mitral Valve Repair

Cohn

Bartuś

Nguyen

2020

Innovations�(Phila)

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“…The importance of neochordae placement location along the leaflet margin has been previously described for a novel technique of beating‐heart, anterior mitral leaflet augmentation, which is also performed using the DS1000 device . Indeed, when a non‐equidistant pattern of chordal placement results on the leaflet segment, as well as on the augmented patch, distortion of the mitral valve and of the patch results leading to procedural failure with the technique.…”

mentioning

confidence: 99%

“…The NeoChord device is introduced through a posterolateral ventriculotomy and advanced toward the mitral valve The importance of neochordae placement location along the leaflet margin has been previously described for a novel technique of beating-heart, anterior mitral leaflet augmentation, which is also performed using the DS1000 device. 5 Indeed, when a non-equidistant pattern of chordal placement results on the leaflet segment, as well as on the augmented patch, distortion of the mitral valve and of the patch results leading to procedural failure with the technique. Figure 4 and Movie S1 demonstrates the increased conspicuity of the neochordae placement locations as observed from intraoperative image sequences from a case performed at our center ( Figure 4 and Movie S1).…”

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confidence: 99%

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

Vairo

Marro

Speziali³

et al. 2019

Echocardiography

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The NeoChord procedure is a micro‐invasive, trans‐ventricular, beating‐heart chordal replacement technique for patients with severe degenerative mitral valve regurgitation resulting from prolapsed or flail leaflets. Three dimensional transoesophageal echocardiographic guidance is crucial to assist the operator during the procedure. Equidistant placement of neochordae along the free edge of the prolapsing leaflet segment is important to ensure uniform stress distribution and to avoid damaging any of the previously placed neochordae. Lowering the image gain associated with the three‐dimensional surgical view of the mitral valve allows for signal attenuation of the native structures delineating the precise placement location of the neochordae.

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Transventricular off-pump anterior mitral leaflet augmentation: First in human

Cited by 5 publications

References 4 publications

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

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

Finding the Future: The 10 Commandments of Beating Heart Mitral Valve Repair

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

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