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Trans-apical, Off-pump Edge-to-Edge Mitral Valve Repair
Richard Daly1, John Zentgraf2, John Seaberg2, Giovanni Speziali2.
1Mayo Clinic, Rochester, MN, USA, 2Neochord, Inc., Eden Prairie, MN, USA.

OBJECTIVE: The edge to edge (E-E) technique is a recognized method to treat mitral regurgitation (MR) and is used in both open and minimally invasive approaches. We report laboratory evaluation of an instrument, which was designed to place artificial chordae tendinae (ACT) on the mitral valve (MV), to create an off-pump, minimally invasive E-E repair of the MV.
METHODS: ACT were placed on opposing aspects of the anterior and posterior leaflets of the MV in swine, off-pump, through a trans-apical approach using echo guidance. Three knot tying techniques were evaluated (knots 1,2,and 3). Acute procedural success (APS) was defined as creation of a double orifice MV by echocardiogram, and good contact of the two leaflets at autopsy. Chronic animals were studied at 3 months.
RESULTS: There were 11 acute studies and 9 chronic studies. Three different knot configurations were evaluated. APS for knots 1, 2 and 3 were (success/total): 1/4, 0/1, and 4/4, respectively.. Chronic success for knots 1, 2 and 3 was 1/2, 1/3 and 2/4, respectively. Knot 3 was placed twice in 2 animals with APS 2/2; the picture shows 2 knots each with attached ACT and forceps through the double orifices of the mitral valve.
CONCLUSIONS: Placement of the ACT on opposing aspects of the two MV leaflets was straightforward. Evolution of knot techniques led to a knot that reliably created an E-E repair acutely. Chronic outcomes may have been compromised by 100% growth in the animal model. Double knots (picture) may improve the area of leaflet coaptation and durability. The technique is unique in that it allows the E-E repair to be supported by ACT.

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