Original articleAdult cardiacGood 5-Year Durability of Transapical Beating Heart Off-Pump Mitral Valve Repair With Neochordae
Section snippets
Patient Selection
Patient inclusion criteria consisted of severe symptomatic mitral regurgitation (MR), isolated prolapse of the posterior mitral leaflet (PML), no or only mild annular dilatation (intercommissural diameter <45 mm), and no additional cardiac pathologic features [5]. Exclusion criteria consisted of anterior or bileaflet prolapse, marked annular dilation, severe left ventricular (LV) dysfunction or aneurysm, and history of endocarditis. All patients were examined by transthoracic echocardiography
Operative Results
A total of 6 consecutive patients from our institution (University of Leipzig-Heart Center, Leipzig, Germany) were included in the TACT trial. All patients were treated with the NeoChord DS1000 system. In 5 patients, the procedure was successfully performed with significant reduction of MR that resulted in no or trace MR (3 patients) or mild MR (2 patients) on intraoperative TEE. Three or more neochordae were applied in each patient, and the intraoperative course was uneventful in these 5
Key Findings
This study shows good long-term results of transapical beating heart off-pump MV repair for isolated PML prolapse with implantation of neochordae in select patients. Echocardiography showed trace and mild MR in 2 patients and mild to moderate MR in 1 patient who were initially included in the TACT trial. Although our study reports on long-term results for only 3 patients, the findings are notable for several reasons.
Early Failure
Intraoperative conversion to open MV operation was necessary in an octogenarian
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Cited by (44)
Mitral valve repair with transapical, off-pump neochord implantation. Initial experience
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2023, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Since the start of its clinical application, more than 1200 cases have been performed worldwide.12 However, scarce midterm FU data are currently available, except for an anecdotal report by Kiefer and colleagues4 describing good 5-year durability of NC in 3 patients. Our results show a cumulative incidence of severe residual MR of 23.7% in the overall population and 14.7% in FA patients.
Midterm results of transventricular mitral valve repair: Single-center experience
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2022, Medical Engineering and PhysicsCitation Excerpt :In particular, regarding the mitral valve, many of the valvular and subvalvular structures undergo cyclical loading conditions that can be replicated or approximated by either a tension or compression linear force application [6–8] Two particular areas that we identified were the motion of chordal and papillary muscle dynamics as well as mitral valve annular forces [9–12] In the event of chordal rupture, transapical minimally invasive artificial chordae is an emerging clinical technology that can be implanted to restore proper function [13–17] However, these techniques put excessive stresses on the chordae and have been implicated in early clinical instances of failure [5,18,19] We developed an elastomeric, silicone artificial papillary muscle to reduce elevated stresses by replicating the elasticity of native papillary muscle tissue [5] As this structure is meant to be implanted within a patient, evaluating its fatigue performance over millions of cardiac cycles is important for assessing its efficacy and safety in the clinical translation process. Another category of implantable devices subjected to repeated loading is that of mitral annuloplasty rings.
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Drs Kiefer and Meier contributed equally to this work.