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OBJECTIVE: On pump mitral valve repair is well established. Off pump mitral valve repair has so far not been feasible. Improved online cardiac imaging techniques like 3D echocardiography enable an improved visualisation of theunderlying pathology and the development of a technique for closed application of neochordae on the prolapsed leaflet segments with a newly developed device, the Neochord DS 1000.
We present our experience with the first three patients repaired with this technique for prolapse of P2.
METHODS: Three pts., mean age (57±3,46 years), 2 male, presented in NYHA I-II with moderate-severe MV regurgitation with P2-prolaps, with excentric jets and vena contracta >8 mm. EF was 55%, 50% and 40%, one patient had moderate pulmonary hypertension and paroxysmal AF, LA-diameter was 47,3±3,5mm, LVEDD:62±10mm, no severe annulus dilatation. Surgery was performed via left minithoracotomy (5th intercostal space, medioclavicular line). The chordal implantation tool was inserted under heparin (ACT 300s) through the lateral ventricular wall under 2D/3D guide with consecutive artificial chordae placement (Gore-Tex 4,0) with the Neochord DS 1000 System. The number of neochordae inserted was 3, 3 and 4. Adjustment was done under sophisticated 2D/3D echo-control.
RESULTS: There was no operative mortality, residual MI was trace in one and zero in two. Pts. were extubated within 3 hours, there were no blood transfusions or other complications. Echo at discharge showed trace or no MR as p.o.
CONCLUSIONS: Off pump minimally invasive mitral valve repair with artificial chordae is feasible with excellent short time results. Long term observation is necessary to prove long-term durability.