Original article
Adult cardiac
Good 5-Year Durability of Transapical Beating Heart Off-Pump Mitral Valve Repair With Neochordae

https://doi.org/10.1016/j.athoracsur.2018.01.092Get rights and content

Background

Transapical, beating heart, off-pump implantation of neochordae for repair of mitral valve (MV) prolapse is of increasing interest. The aim of this study was to evaluate long term results for MV repair using the NeoChord system (NeoChord, St. Louis Park, MN).

Methods

Six patients underwent treatment for severe primary mitral regurgitation (MR) with the NeoChord DS1000 system as part of the initial device safety and feasibility Transapical Artificial Chordae Tendinae (TACT) trial at our institution (University of Leipzig-Heart Center, Leipzig, Germany). The primary pathology in all patients was isolated posterior leaflet prolapse of the P2 or P3 segment, or both.

Results

Successful repair resulting in no or trace MR was achieved in 5 of 6 patients by implantation of three neochordae under transesophageal echocardiographic guidance and normal left ventricular loading conditions. One patient underwent intraoperative conversion to an open MV replacement as a result of leaflet injury. The early postoperative course was uneventful in all remaining patients. Two patients had to undergo reoperation for recurrent MR at 3 and 16 months postoperatively. The remaining 3 patients were followed up for a period of 5 years. These patients were free of cardiac symptoms, and transthoracic examination showed trace or mild to moderate MR at 1-, 2-, and 5-year follow-up. A trend toward reverse remodeling of the left ventricle with no increase in mitral annular dilatation over 5 years was observed.

Conclusions

In select patients, MV repair using the NeoChord system results in very good long-term results without recurrent prolapse, MR, or annular dilatation.

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

Cited by (44)

  • Outcomes of transapical mitral valve repair with neochordae implantation

    2023, Journal of Thoracic and Cardiovascular Surgery
    Citation 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.

  • A novel accelerated fatigue testing system for pulsatile applications of cardiac devices using widely translatable cam and linkage-based mechanisms

    2022, Medical Engineering and Physics
    Citation 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.

View all citing articles on Scopus

Drs Kiefer and Meier contributed equally to this work.

View full text