Off-pump transapical implantation of artificial chordae to correct mitral regurgitation: Early results of a single-center experience

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 147; no. 1; pp. 95 - 99
• Main Authors: Rucinskas, Kestutis, MD, Janusauskas, Vilius, MD, Zakarkaite, Diana, MD, Aidietiene, Sigita, MD, Samalavicius, Robertas, MD, Speziali, Giovani, MD, Aidietis, Audrius, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 2014
• Subjects: Adult; Aged; Cardiopulmonary Bypass; Cardiothoracic Surgery; Chordae Tendineae - surgery; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Lithuania; Male; Middle Aged; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Mitral Valve Prolapse - diagnosis; Mitral Valve Prolapse - physiopathology; Mitral Valve Prolapse - surgery; Prospective Studies; Prosthesis Design; Recurrence; Reoperation; Severity of Illness Index; Stroke Volume; Suture Techniques; Thoracotomy; Time Factors; Treatment Outcome; Ventricular Function, Left; Lithuania; left ventricle; MR; mitral regurgitation; TEE; 28; Transapical Artificial Chordae Tendineae [trial]; TACT; LV; transesophageal echocardiography; 35.4.1
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2013.08.012

Objectives This study evaluated the safety and efficiency of the NeoChord DS1000 system (NeoChord, Inc, Minneapolis, Minn), a device designed to deliver artificial chordae tendineae ( neochords ) in a beating heart with minimally invasive techniques through left anterolateral minithoracotomy. Methods Thirteen patients with severe mitral regurgitation and isolated posterior mitral valve leaflet prolapsed underwent operation with the NeoChord DS1000 system. Mitral valve dimensions were anteroposterior 34 mm (29-45 mm) and mediolateral 40 mm (29-58 mm). All patients had an ejection fraction greater than 55%. With a beating heart, through a left anterolateral thoracotomy, under transesophageal echocardiographic guidance, the NeoChord DS1000 was introduced into the left ventricle 2 to 4 cm posterolateral from the apex. The prolapsed leaflet was grasped with the device, and expanded polytetrafluoroethylene suture deployed and attached to the posterior leaflet. Six patients received 2 sutures, 4 received 3 sutures, and 2 received 4 sutures. All patients reached 6 months' follow-up and underwent transthoracic echocardiography to evaluate mitral regurgitation. Results Median operative duration was 113 minutes (80-150 minutes). Less than second-degree mitral regurgitation in 6 months was achieved in 11 patients (85%). One patient (8%) had recurrent mitral regurgitation in 1 month, and another had conversion to conventional mitral valve repair because of leaflet damage with the device. There were no further serious procedure-related complications. Conclusions Beating-heart transapical neochord implantation was feasible, could be performed safely, and resulted in a relatively short procedure time. Larger studies and longer follow-up are needed to validate these promising results.