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

Abstract

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.

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

“…Echo-guided transapical implantation of artificial chordae on a beating heart with the NeoChord DS1000 system is a novel technique to treat degenerative MR, which has been the first transapical technique approved for MV repair in patients with MR due to prolapse or flail leaflet [10, 11, 13].…”

“…Our initial experience in the first 2 patients with posterior mitral leaflet prolapse treated with the NeoChord system was described in 2017 [11].…”

“…Knots with the neochordae were tied on the leaflet and their free ends were secured on the muscle of the LV. Details of the NeoChord procedure are described in a previous publication from 2017 [11]. The procedures were performed by one surgeon and by the same echocardiography specialist.…”

“…In recent years, minimally invasive transapical techniques of MV surgery have been increasingly used [10]. Transapical implantation of artificial polytetrafluoroethylene chordae on a beating heart with the NeoChord DS1000 system using two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) guidance is a new minimally invasive surgical technique to treat degenerative MR [11].…”

“…This technique facilitates implantation of neochords fixed not to papillary muscles, but the apical area without complementary annuloplasty. Chordal length adjustment is done on the beating heart [11]. There are no data indicating whether this technique produces durable results comparable with conventional surgery.…”