Transapical Off-Pump Implantation of Artificial Cordae in Mitral Valve Regurgitation
Nalan Schnelle1, Horst Sievert2, Laura Vaskelyte2, Dilek Ister1, Christian F. Vahl1.
1University of Mainz, Mainz, Germany, 2Cardiovascular Center Frankfurt, Frankfurt, Germany.
OBJECTIVE: The present study describes the initial experience with the NeoChord DS System, that allows transapical implantation of artificial neochordae in terms of periprocedural safety, clinical success and short term outcome in four patients.
METHODS: Patients with dyspnea and NYHA functional class II-IV with severe mitral regurgitation were included that did not accept open heart mitral valve repair (F: 70y, MR III-IV due to P2-P3 prolaps; M: 88y, MR IV due to A1-A2 prolaps; M: 76 y, MR III due to P2-P3 prolaps with prior mitral valve annuloplasty and chordae implantation at P2/P3; F 75: MR IV due to P2-P3 prolaps). We decided in the heart team on transapical repair with NoeChord under general anesthesia. The NeoChord procedure was performed under 2- and 3-dimensional transoesophageal guidance using a transapical access. After grasping the MV-leaflet with two grippers, valvular piercing and fixation and retraction of the neo-chordae were performed. In any patient 6 Neochordae were implanted (3 pairs)
RESULTS: The patients received multiple chordae. The precedures were uneventfull with no hemodynamical instability. The perioperative results were excellent with no regurgitation left in three patients and MI I in one patient. No bleeding, no infection. Discharge was performed within 7-10 days after the procedure. No cardiovascular or neurological complications were observed (no adverse event).
CONCLUSIONS: Despite the small patient population off pump transapical implantation of neochordae seems feasible, efficient and safe without actually increase in the transvalvular gradient in comparison to mitral clip. It is even successful following prior mitral valve annuloplasty and chordae implantation. The dynamic physiological approach with stepwise resuspension of a leaflet without use of cardiopulmonary bypass has to be reserved for high risk patients as long as long term results are not available.
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