Off-pump transapical implantation of artificial chordae to correct mitral regurgitation: early results of a single-center experience

J Thorac Cardiovasc Surg. 2014 Jan;147(1):95-9. doi: 10.1016/j.jtcvs.2013.08.012. Epub 2013 Oct 5.


Objectives: This study evaluated the safety and efficiency of the NeoChord DS1000 system (NeoChord, Inc, Minneapolis, Minn), a device designed to deliver artificial chordae tendineae (neochords) in a beating heart with minimally invasive techniques through left anterolateral minithoracotomy.

Methods: Thirteen patients with severe mitral regurgitation and isolated posterior mitral valve leaflet prolapsed underwent operation with the NeoChord DS1000 system. Mitral valve dimensions were anteroposterior 34 mm (29-45 mm) and mediolateral 40 mm (29-58 mm). All patients had an ejection fraction greater than 55%. With a beating heart, through a left anterolateral thoracotomy, under transesophageal echocardiographic guidance, the NeoChord DS1000 was introduced into the left ventricle 2 to 4 cm posterolateral from the apex. The prolapsed leaflet was grasped with the device, and expanded polytetrafluoroethylene suture deployed and attached to the posterior leaflet. Six patients received 2 sutures, 4 received 3 sutures, and 2 received 4 sutures. All patients reached 6 months' follow-up and underwent transthoracic echocardiography to evaluate mitral regurgitation.

Results: Median operative duration was 113 minutes (80-150 minutes). Less than second-degree mitral regurgitation in 6 months was achieved in 11 patients (85%). One patient (8%) had recurrent mitral regurgitation in 1 month, and another had conversion to conventional mitral valve repair because of leaflet damage with the device. There were no further serious procedure-related complications.

Conclusions: Beating-heart transapical neochord implantation was feasible, could be performed safely, and resulted in a relatively short procedure time. Larger studies and longer follow-up are needed to validate these promising results.

Keywords: 28; 35.4.1; LV; MR; TACT; TEE; Transapical Artificial Chordae Tendineae [trial]; left ventricle; mitral regurgitation; transesophageal echocardiography.

MeSH terms

  • Adult
  • Aged
  • Cardiopulmonary Bypass
  • Chordae Tendineae / surgery*
  • Echocardiography, Transesophageal
  • Female
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Lithuania
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery*
  • Mitral Valve Prolapse / diagnosis
  • Mitral Valve Prolapse / physiopathology
  • Mitral Valve Prolapse / surgery*
  • Prospective Studies
  • Prosthesis Design
  • Recurrence
  • Reoperation
  • Severity of Illness Index
  • Stroke Volume
  • Suture Techniques
  • Thoracotomy
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left