Ecallantide was less effective at reducing perioperative blood loss than tranexamic acid. High-dose tranexamic acid was more effective than the low dose in reducing blood loss.

A b s t r a c tBackground: Artificial chord implantation to repair a flail or prolapsing mitral valve leaflet requires open heart surgery and cardiopulmonary bypass.Aim: Transapical off-pump artificial chordae implantation is a new surgical technique proposed to treat degenerative mitral valve regurgitation. The procedure is performed using the NeoChord DS1000 system (NeoChord, Inc., St. Louis Park, MN, USA), which facilitates both implantation and lenght adjustment of the artificial chordae under two (2D)-and three (3D)--dimensional transoesophageal echocardiographic (TEE) guidance on a beating heart. Methods: Two male patients aged 60 and 55 years with severe mitral regurgitation due to posterior leaflet prolapse underwent transapical off-pump artificial chordae implantation on September 3, 2015. The procedure was performed by left minithoracotomy under general anaesthesia in a cardiac surgical theatre, using 2D and 3D TEE guidance. Results:Early procedural success as confirmed by 3D TEE was achieved in both patients, with implantation of 6 artificial chordae in the first patient and 3 artificial chordae in the second patient. Both procedures were uneventful, and no postoperative complications were noted. The patients were discharged home on the 8 th and 6 th postoperative day, respectively. Conclusions:The NeoChord DS1000 system allows both implantation and lenght adjustment of artificial chordae under 2D and 3D TEE guidance on a beating heart. Our initial experience in 2 patients with posterior mitral leaflet prolapse indicates that the procedure is feasible and safe.

Introduction: Trans-apical beating heart off-pump mitral valve (MV) repair is a novel surgical technique for treating mitral regurgitation (MR) caused by degenerative flail/prolapse (DLP). Aim: To present early outcomes of a single-center experience with transapical beating heart mitral valve repair with the NeoChord system. Material and methods: Thirty-seven patients with severe symptomatic MR were treated with the NeoChord technique between September 2015 and December 2018 (78% men; mean age: 62.3 ±13.4 years). We evaluated standard cardiac surgery perioperative complications as well as those related to the NeoChord technique as well as early surgical success as defined by the reduction of MR to less than moderate by implantation of at least 2 neochordae. Results: During this series we had no hemodynamic instability due to bleeding or arrhythmia. There were no transapical technique-related adverse events such as a leaflet perforation or tear, a major native chord rupture, which would require implantation of a new chord, ventricular apex rupture, or left atrial perforation. There were no major adverse events including death, stroke or acute myocardial infarction. Nine (24%) patients developed an episode of perioperative atrial fibrillation. We were able to conclude the operation in 98% of our patients with less than moderate MR. One (2%) patient had moderate MR at the conclusion of the operation. Conclusions: Trans-apical off-pump MV repair with the NeoChord system is a safe, minimally invasive procedure, with few minor complications. In well-selected candidates it provides successful treatment of degenerative MR. Results are anatomy dependent, so preoperative patient selection is crucial.

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