Transapical off-pump mitral valve repair with Neochord implantation: Early clinical results

Int J Cardiol. 2016 Feb 1;204:23-8. doi: 10.1016/j.ijcard.2015.11.131. Epub 2015 Nov 23.

Abstract

Background: This prospective study aims to assess early clinical outcomes in patients undergoing Transapical Off-Pump Mitral Valve Intervention with Neochord Implantation (TOP-MINI).

Methods and results: Forty-nine patients with severe symptomatic degenerative mitral regurgitation (MR) were treated. Median age was 72 years (IQR 58-78) and median Euroscore-I was 3.26% (IQR 0.88-8.15). Forty-four patients (89.8%) presented with posterior leaflet prolapse (LP), 4 (8.2%) with anterior LP and 1 (2%) with combined disease. Acute procedure success (defined as successful placement of at least 3 neochords with reduction of residual MR to less than 2+) was achieved in all patients. In-hospital mortality was 2%. At 30 days major adverse events included one AMI (2%) successfully treated percutaneously and one sepsis (2%), no stroke or bleeding events occurred. At 3 months overall survival was 98%. MR was absent in 16 patients (33.4%), was grade 1+ in 15 (31.2%), and was grade 2+ in 12 (25%). Five patients (10.4%) developed recurrent severe MR due to anterior native chordae rupture. Four of them were successfully re-operated. At 3 months follow-up freedom from reoperation was 91.7 ± 4%.

Conclusions: Early results with Neochord procedure indicate that TOP-MINI is feasible and safe. Efficacy is maintained up to 3 months follow-up with significant clinical benefit for the patients.

Keywords: Mitral valve regurgitation; Mitral valve repair; Off-pump; Transapical.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chordae Tendineae / diagnostic imaging*
  • Chordae Tendineae / surgery*
  • Coronary Artery Bypass, Off-Pump*
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / diagnostic imaging*
  • Mitral Valve Insufficiency / surgery*
  • Prospective Studies
  • Treatment Outcome
  • Ultrasonography