Transapical neochord implantation: Is tension of artificial chordae tendineae dependent on the insertion site?

Jensen, Henrik; Jensen, Morten Ø.; Waziri, Farhad; Honge, Jesper L.; Sloth, Erik; Fenger‐Grøn, Morten; Nielsen, Sten Lyager

doi:10.1016/j.jtcvs.2013.07.068

Cited by 34 publications

(52 citation statements)

References 12 publications

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“…In addition to leaflet morphology, the site of left ventricular puncture is another significant factor affecting treatment outcomes. The technique used during these first procedures in Poland was modified based on the previous experience [10], with left ventricular puncture performed more posteriorly.…”

Section: Discussionmentioning

confidence: 99%

Transapical off-pump mitral valve repair. First experience with the NeoChord system in Poland (report of two cases)

Wróbel¹,

Kurnicka

Zygier

et al. 2017

Kardiol Pol

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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.

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Section: Discussionmentioning

confidence: 99%

Transapical off-pump mitral valve repair. First experience with the NeoChord system in Poland (report of two cases)

Wróbel¹,

Kurnicka

Zygier

et al. 2017

Kardiol Pol

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“…Stress/strain curves and Young modulus of the different specimen were evaluated. Every specimen were strained at a speed of 30 mm/min, to a maximum load of 0,75 N (75 g), to obtain the same tension to which chordae are exposed on average in the human body …”

Section: Methodsmentioning

confidence: 99%

A study of the mechanical properties of ePTFE suture used as artificial mitral chordae

Caimmi¹,

Sabbatini

Fusaro

et al. 2016

J Card Surg

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“…This approach is useful in isolated mitral valve leaflet(s) prolapse with lower operative risk [44]. However, no high-quality studies have investigated the possibility of implantation in severe HF situations with LVD and mitral leaflet thethering.…”

Section: Surgical Mitral Valve Repairmentioning

confidence: 99%

“…Transapical correction using NeoChord has been popularized in degenerative MR, and the new devices facilitate transapical implantation of neo-chordae on the beating heart without cardiopulmonary bypass (CPB) [43]. This approach is useful in isolated mitral valve leaflet(s) prolapse with lower operative risk [44]. However, no high-quality studies have investigated the possibility of implantation in severe HF situations with LVD and mitral leaflet thethering.…”

Section: Surgical Mitral Valve Repairmentioning

confidence: 99%

Invasive Treatment in Advanced (Stage-D) Heart Failure

Kırali¹,

Yerlikhan²,

Hançer³

2017

Cardiomyopathies - Types and Treatments

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Heart failure is a complex, true pandemic clinical syndrome and is responsible for 5% of hospitalizations globally. Severe heart failure can manifest as two lethal clinical entities: (1) acute cardiac decompensation with cardiogenic shock after large acute myocardial infarction with mortality rates approaching 50% or after cardiac surgery with mortality rates higher than 65% and (2) chronic destructive cardiac remodeling or acute decompensative exacerbations of cardiomyopathies with one-year mortality of approximately 80% (worse than most types of cancer). Interventional therapies aim first to improve symptoms and life expectancy in patients with severe heart failure syndrome, second to prevent left ventricular remodeling, and third to bridge patients to long-term mechanical circulatory support or transplantation. Several treatment options can be used to stabilize patients. In particular, new percutaneous mitral valve interventions and short-term circulatory support devices open up a new temporary treatment area in symptomatic Stage-D heart failure. The durable or curable surgical destination treatment will be only permanent ventricular assist devices or heart transplantation. This chapter focuses on the treatment steps and new approaches in hospitalized Stage-D heart failure patients.Keywords: heart failure, heart transplantation, ventricular assist device, ECMO, ECLS At end-stage, any type of cardiomyopathy (CMP) causes a complex clinical heart failure (HF) syndrome, which results from structural and/or functional impairment of ventricular filling or ejection. This dire clinical situation can cause an adverse vicious cycle that is ultimately fatal if not treated by pharmacological or invasive mechanical support or heart transplantation (HTx). Left ventricular functional abnormalities range from normal-sized left ventricle (LV) with preserved left ventricular ejection fraction (LVEF) to severe left ventricular dilatation (LVD) with markedly reduced LVEF. Reduced LVEF is defined as the clinical diagnosis of HF and LVEF ≤40%, which means a clinic and functional association of systolic and/or diastolic LVD.© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abnormal systolic and/or diastolic functions impair left ventricular contractile and relaxation functions that result in increasing left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV), as well as left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), with the alteration of the left ventricular shape from conical form to spherical form. Adverse elevation of preload and afterload results in increasing left ventricular end-diastolic pressure (LVEDP) and left ventricular end-systolic pressure (LVESP). Inadequate unloading is the pr...

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Transapical neochord implantation: Is tension of artificial chordae tendineae dependent on the insertion site?

Abstract: Overall, the chordal insertion site had little influence on the tension in the artificial neochordae compared with the interindividual variation. However, abnormal tension fluctuations in the transapically fixated neochordae might predispose to leaflet tears and early repair failure.

Cited by 34 publications

References 12 publications

Transapical off-pump mitral valve repair. First experience with the NeoChord system in Poland (report of two cases)

Transapical off-pump mitral valve repair. First experience with the NeoChord system in Poland (report of two cases)

A study of the mechanical properties of ePTFE suture used as artificial mitral chordae

Invasive Treatment in Advanced (Stage-D) Heart Failure

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