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OBJECTIVE: Transapical beating heart mitral valve repair (MV) is a novel surgical technique to correct mitral regurgitation (MR) due to prolapse. It facilitates the implantation of neo-chordae to the prolapsing segment of the MV. We herein assess the feasibility/ effectiveness of 3D-real-time transesophageal echocardiography to guide the procedure in men.
METHODS: A standard transapical access is installed and the NeoChord DS-1000 device (Neochord, Minnetonka, MN, USA) is introduced through the LV apex. The device is identified within the LV cavum and advanced through the MV into the LA exclusively under echocardiographic guidance using the X-plane view (MV commissural/ midesophageal long-axis view). The alignment of the grippers towards the prolapsing segment of the leaflet is then accomplished under 3D-zoom view. Subsequent grasping of the leaflet is conducted under X-plane. Functional neochordae length adjustment is carried out under 3D-zoom and X-plane view. Final assessment of the repair before definite fixation of neochordae to the apex is done using color-flow full volume mode.
RESULTS: 3D-real-time transesophageal echocardiography successfully guided the implantation of neo-chordae in six patients to re-suspend prolapsing MV leaflets in a transapical beating heart approach. It was highly applicable in terms of adequate intracardiac orientation, verification of the prolapsing segment, alignment of grippers, grasping of MV leaflets, length adjustment and final assessment of the intraoperative result.
CONCLUSIONS:Transapical beating heart MV repair is feasible and corrects MR due to MV prolapse. This initial experience highlights the feasibility and value of 3D-real-time transesophageal echocardiography to effectively guide the procedure.