Early echocardiographic results of transapical off-pump mitral valve repair with the NeoChord DS1000 device in patients with severe mitral regurgitation due to posterior leaflet prolapse: first experiences in Poland

Abstract

Introduction Minimally invasive techniques of mitral valve (MV) repair have been increasingly used in recent years. Transapical implantation of artificial chordae on a beating heart under 2D/3D transesophageal echocardiographic guidance with the NeoChord DS1000 device is a new surgical treatment of degenerative mitral regurgitation (MR). Aim To evaluate early results of MV repair with the NeoChord DS1000 device in the first group of consecutive patients operated on in Poland. Material and methods Twenty-one patients with severe MR due to posterior leaflet prolapse (81% male; mean age: 60.7 ±12.7 years) underwent MV repair with the NeoChord DS1000 system. There were 12 (57.1%) patients with type A (an isolated central prolapse/flail), 8 (38.1%) patients with type B (multisegment disease/flail) and 1 (4.8%) patient with type C (posterior/paracommisural area) MV prolapse. A flail leaflet was present in 12 (57.1%) patients. The median number of neochords was 3 (2–6). We assessed by echocardiography left-sided heart morphology and evaluated MR degree before and 6 months after chords implantation. Results Early procedural success was achieved in 100% of patients. At the 6-month follow-up nonsignificant MR (trace and mild) was detected in 17 (81.0%) patients, while moderate MR was detected in 4 (19.0%) patients; mean values of left-sided heart dimensions and volumes, mitral E and E’ velocity of lateral MV annulus significantly decreased. Conclusions A novel procedure with the NeoChord DS1000 device is feasible in properly selected patients, and results in a significant reduction of MR degree and left ventricle and left atrium reverse remodeling at the 6-month follow-up.

Transapical off‐pump mitral valve repair with NeoChord implantation: A systematic review

“…Colli et al 11 Overlap of included patients with Colli et al 12 Colli et al 13 Overlap of included patients with Colli et al 12 Colli et al 14 Overlap of included patients with Colli et al 12 Colli et al 15 Overlap of included patients with Colli et al 12 Colli et al 16 Overlap of included patients with Colli et al 12 Colli et al 17 Overlap of included patients with Colli et al 12 Kurnicka et al 6 Overlap of included patients with Colli et al 12 Rucinskas et al 18 Overlap of included patients with Colli et al 12 Samalavicius et al 19 Overlap of included patients with Colli et al 12 Wrobel et al 7 Overlap of included patients with Colli et al 12 Seeburger et al 20 Overlap of included patients with Colli et al 12 and Kiefer et al 21 Kavakli et al 22 Overlap of included patients with Kavakli et al 23…”

“…It has gained increasing recognition as a feasible, safe, and effective procedure with minor complications and excellent outcome. 6,7 While the device is approved for clinical use in European countries, it is not yet approved in the United States. Currently, there are two ongoing studies evaluating the performance of the procedure in Germany (ClinicalTrials.gov identifier: NCT04190602) and in the United States (ClinicalTrials.gov identifier: NCT02803957) with expected completion dates at 2027 and 2025, respectively.…”

“…The latter technique entails the implantation of artificial chordae on a beating heart under transesophageal echocardiographic guidance. It has gained increasing recognition as a feasible, safe, and effective procedure with minor complications and excellent outcome 6,7 . While the device is approved for clinical use in European countries, it is not yet approved in the United States.…”

Actual perspective on off‐pump transapical artificial chord implantation

“…Published results of transapical chordal implantation show significant percentages of more than mild residual mitral regurgitation. 5,6,8,11,38,39 Gammie et al 23 introducing Harpoon results in their series of more than 60 patients show at 30 days 13% of moderate MR and 2% of severe MR. At 1 year, these percentages increase up to 23% and 2% for moderate and severe MR, respectively; 13% of the patients required reoperations. Lozos et al, 10 publishing the results of the first experience in Greece with Neochord DS1000, presented a 16% and 7% of moderate and severe residual MR, respectively.…”

“…This relatively new device, 1 follows the footsteps of Neochord (Neochord, Inc.) and Harpoon (Edwards Lifesciences) and permits the positioning of polytetrafluoroethylene (ePTFE) artificial chordae through a transapical off‐pump ventricular access. The efficacy and safety of this solution have already been demonstrated mainly thanks to the worldwide expansion of the Neochord experience 2–26 …”