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Re-intervention After Recurrence Of Mitral Regurgitation After Mitral Valve Repair: Off-pump Neochords Implantation Vs Standard Surgery
Stefano Salizzoni1, Cristina Barbero
2, Giulia Agostini
1, Alessandro Vairo
2, Marco Pocar
1, Cecilia Capozza
1, Erik Cura Stura
1, Matteo Giunta
2, Matteo Marro
2, Antonello Carmeci
2, Anna Trompeo
2, Mauro Rinaldi
1.
1University of Turin, Turin, Italy,
2Cittą della Salute e della Scienza, Turin, Italy.
BACKGROUND: Recurrence of mitral regurgitation (MR) due to leaflet prolapse after mitral valve repair (MVr) may lead to re-intervention, with high risk of morbidity and mortality and challenging re-repair. The aim of this study is to compare the results of patients with failed MVr with annuloplasty that underwent trans-ventricular off-pump mitral valve re-repair with ePTFE NeoChords implantation (NC) or Standard Re-Surgery (SRE).
METHODS: Between 2006 and 2024, patients with recurrence of severe MR with similar anatomical mitral valve characteristics were retrospectively enrolled. All patients had a previous MVr with ring annuloplasty. Patients with tethering, active clefts, endocarditis and stenosis were excluded. The 36 enrolled patients were divided in two groups: 14 NC; 22 SRE, that where reoperated through right mini-thoracotomy (13) or sternotomy (9).
RESULTS: There was no statistically significant difference in terms of age (67±4.9 vs 64±9.9), gender (female 28.6 % vs 18.2 %), LVEF (58.4±10.6 % vs 58.4±8.2%), and EuroSCORE II (3.4±1.1 vs 3.1±1.8). All patients in the NC group underwent successful MVr with a median of three (minimum 2 and maximum 6) implanted chords while in group SRE 11 (50%) patients needed a MV replacement (p=0.007). Six patients (43%) in NC group did not need ICU stay (p=0.003). Transfusions were higher in SRE Group (7.1% vs 22.7%, p=0.007). There were no 30-day mortality. Days of hospitalization were significantly lower in NC group (4±1 vs 7.8±2.7). At maximum follow-up no deaths nor significant MR recurrence were reported. In the NC group one patient underwent reintervention after 27 months because of endocarditis. Echocardiographic long-term follow-up is ongoing.
CONCLUSIONS: In patients with recurrence of MR due to leaflet prolapse in previous standard MVr with annuloplasty, the trans-ventricular off-pump mitral valve re-repair with ePTFE NeoChords implantation technique showed excellent short-term results for safety (mortality and complications) and efficacy (success of re-repair), therefore it may become a valid alternative to standard re-surgery in these selected patients. Higher numerosity and longer-term follow-up may lead this micro-invasive technique to become the standard of care.
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