Good 5-Year Durability of Transapical Beating Heart Off-Pump Mitral Valve Repair With Neochordae

Ann Thorac Surg. 2018 Aug;106(2):440-445. doi: 10.1016/j.athoracsur.2018.01.092. Epub 2018 May 2.


Background: Transapical, beating heart, off-pump implantation of neochordae for repair of mitral valve (MV) prolapse is of increasing interest. The aim of this study was to evaluate long term results for MV repair using the NeoChord system (NeoChord, St. Louis Park, MN).

Methods: Six patients underwent treatment for severe primary mitral regurgitation (MR) with the NeoChord DS1000 system as part of the initial device safety and feasibility Transapical Artificial Chordae Tendinae (TACT) trial at our institution (University of Leipzig-Heart Center, Leipzig, Germany). The primary pathology in all patients was isolated posterior leaflet prolapse of the P2 or P3 segment, or both.

Results: Successful repair resulting in no or trace MR was achieved in 5 of 6 patients by implantation of three neochordae under transesophageal echocardiographic guidance and normal left ventricular loading conditions. One patient underwent intraoperative conversion to an open MV replacement as a result of leaflet injury. The early postoperative course was uneventful in all remaining patients. Two patients had to undergo reoperation for recurrent MR at 3 and 16 months postoperatively. The remaining 3 patients were followed up for a period of 5 years. These patients were free of cardiac symptoms, and transthoracic examination showed trace or mild to moderate MR at 1-, 2-, and 5-year follow-up. A trend toward reverse remodeling of the left ventricle with no increase in mitral annular dilatation over 5 years was observed.

Conclusions: In select patients, MV repair using the NeoChord system results in very good long-term results without recurrent prolapse, MR, or annular dilatation.

MeSH terms

  • Aged
  • Chordae Tendineae
  • Echocardiography / methods
  • Echocardiography, Transesophageal / methods*
  • Education, Medical, Continuing
  • Female
  • Follow-Up Studies
  • Germany
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / surgery*
  • Mitral Valve Prolapse / complications
  • Mitral Valve Prolapse / diagnostic imaging
  • Mitral Valve Prolapse / surgery*
  • Patient Selection
  • Prosthesis Design
  • Quality Improvement
  • Risk Assessment
  • Sampling Studies
  • Severity of Illness Index
  • Surgery, Computer-Assisted / methods*
  • Time Factors
  • Treatment Outcome