Feasibility of percutaneous coronary intervention before mitral NeoChord implantation: Single‐center early results

Abstract

Background and Aim of the study Micro‐invasive cardiac surgery identifies procedures performed off‐pump, on beating heart. Aim of this single‐center retrospective study was to assess early outcomes of a totally micro‐invasive strategy (percutaneous coronary intervention—PCI—followed by transapical off‐pump NeoChord mitral repair) in patients with concomitant coronary artery disease (CAD) and degenerative mitral regurgitation (MR). Methods We analyzed early and 1‐year follow‐up data of patients who underwent a NeoChord procedure between November 2013 and May 2020, and preceded by PCI. Outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions. Results Among 220 patients who underwent NeoChord repair in the study period, 17 (7.7%) underwent PCI previously. CAD was an accidental finding during preoperative mitral evaluation in nine patients (52.9%; Group 1; with PCI occurring 2 months before NeoChord, interquartile range [IQR] = 1.0–2.7), while it was part of the past medical history in the remaining eight patients (47.1%; Group 2; with PCI occurring 30 months before NeoChord, IQR = 24.5–64.0). Twelve patients (70.6%) presented single‐vessel disease, two patients (11.8%) triple‐vessel disease. No surgical revisions for bleeding were required after NeoChord. At 1‐year follow‐up (n = 16), all patients were alive and did not experience major adverse events except for one reoperation due to late NeoChord failure. None required additional PCI. Conclusion In our experience, PCI before NeoChord seems safe and effective, and performing PCI before NeoChord might not affect outcomes. A totally micro‐invasive strategy in selected patients suffering from MR and CAD should be considered as a reasonable alternative to conventional surgery.

New approach to the mitral valve through the left anterior minithoracotomy for combined valve and coronary surgical procedures

“… 8 A combination of percutaneous coronary implantation with robotic MV repair or replacement has been described by Adams and colleagues 9 or with transapical NeoChords MV repair by Pradegan and colleagues. 10 Simultaneous MIDCAB procedure and transapical NeoChords have been described by Albertini and colleagues. 11 Combining coronary beating heart surgical revascularization through the left anterolateral thoracotomy and followed by Tendyne transapical MV replacement therapy has been described by Miazza and colleagues.…”

Sternal-Sparing Transapical, Beating Heart Mitral Valve Repair in an Adult With Repaired Tetralogy of Fallot

“… 4 Microinvasive surgery includes procedures that mimic conventional operations but are performed off-pump on a beating heart (eg, transapical neochordae implantation). 5 , 6 Thus far, as with transcatheter aortic valve replacement and edge-to-edge mitral valve repair, microinvasive procedures are still not widely performed in ACHD.…”

Percutaneous coronary intervention before NeoChord mitral valve repair: Expanding the spectrum of hybrid procedures

“…This lack of evidence has motivated active research to determine the real clinical impact of revascularization. To this end, in this issue of the Journal , Pradegan et al 3 examine the feasibility of performing percutaneous coronary intervention (PCI) before transapical off‐pump NeoChord mitral valve repair (microinvasive procedure) to treat significant degenerative MR.…”

“…The data from Pradegan et al 3 suggest that performing (PCI) before transapical off‐pump NeoChord mitral valve repair (microinvasive procedure) in selected patients is safe and effective and it seems that a history of PCI before the procedure, regardless of timing does not have any impact on postprocedural outcomes. We should take a note of caution when we consider these results.…”