International Society For Minimally Invasive Cardiothoracic Surgery

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Single Centre Experience Of Two Novel Transventricular Neochord Systems For Beating-Heart Repair Of Degenerative Mitral Regurgitation
Rashmi Yadav, Alison Duncan, Mindaugus Norkunas, Ricky Vaja, Neil Moat.
Royal Brompton Hospital, London, United Kingdom.

Background: Surgical repair of degenerative mitral regurgitation (MR) in experienced hands can be achieved with very good results albeit with risks of mortality and stroke. We report our experience with two innovative transventricular chordal implant systems, designed to treat patients with severe degenerative MR without cardiopulmonary bypass, on the beating heart. Methods: Both technologies are designed to facilitate ePTFE neochordal implantation to correct mitral leaflet prolapse, although the mechanisms of attachment to the leaflet differ. Chordae are introduced through LV free wall puncture, via non-rib-spreading thoracotomy and secured to LV free wall after optimization of length to abolish MR as guided by real-time 2-dimensional and 3-dimensional TOE guidance. Results: Between April 2016 and December 2017, 16 patients were treated for severe MR, eight in each group. The NEOCHORD device was used on compassionate grounds in high surgical risk patients with a mean age of 71.84.4 years, mean Euroscore-II of 2.30.5 and mean PA pressure of 50.85.6. 50% of patients had undergone previous major cardiac or thoracic surgery. The HARPOON device was used in low risk patients as part of pre-CE marking study. These patients had lower mean age and Euroscore-II and less pulmonary hypertension (age 57.93.1 years, p=0.02; Euroscore-II 0.720.10, p=0.01; mean PA pressure 30.42.5, p=0.01). One patient in each group had moderate MR on completion of procedure. One patient in the NEOCHORD group had a salvage procedure for severe heart failure. We were unable to implant any chords leaving severe MR and the patient died 28 days later. There were no strokes, conversion to sternotomy, re-exploration for bleeding, renal failure or new permanent pacemaker. Results were stable at 3 and 6 months post-procedure with one patient requiring surgery (repair) for late failure in the HARPOON group. Conclusions: Although, the NEOCHORD and HARPOON devices were used in two very distinct groups of patients, both systems resulted in successful resolution of MR in vast majority of patients. Recovery was rapid with high patient satisfaction and future options for surgery were preserved. However, despite promising early results, rigorous follow up is required prior to more widespread adoption of this innovative technology.


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