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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Transapical off-pump mitral valve repair with neochordoplasty – initial experience in Portugal.
Session:
Posters 2 - Écran 4 - Intervenção / Cirurgia Cardíaca
Speaker:
Sara Simões Costa
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.10 Cardiovascular Surgery – Minimally Invasive Surgery
Session Type:
Posters
FP Number:
---
Authors:
Sara Simões Costa; João Pedro Monteiro; Tiago Jürgen Millner; Paulo Costa Neves; Daniel Borges Martins; Nelson Santos; José Ribeiro; Pedro Braga; Luís Vouga
Abstract
<p>Transapical off-pump neochordoplasty repair is a minimally invasive surgical procedure, to treat degenerative mitral valve regurgitation of increasing interest. It has been demonstrated to be safe and effective in selected patients. The procedure is performed using the NeoChord DS1000™ system under 2D and 3D transesophageal echocardiographic (TEE) guidance on a beating heart. The aim is to demonstrate the safety and feasibility of the surgical technique and our short-term results for mitral valve repair using the NeoChord DS1000™ system. </p> <p>Between December 2017 and August 2018, 8 patients underwent transapical off-pump mitral valve repair with neochordoplasty. The procedure was performed by left minithoracotomy, under general anaesthesia, using 2D and 3D TEE guidance. All patients presented with severe primary mitral regurgitation due to flail/prolapse of 1 leaflet (anterior or posterior). Primary end points were freedom from mortality, myocardial infarction, stroke, reintervention and recurrence of severe mitral regurgitation. Also, we analyzed baseline and postoperative transthoracic or transesophageal echocardiography, comparing grading of mitral regurgitation, left ventricle indexed end diastolic volume and ejection fraction.</p> <p>The average age was 61 years, 6 patients were male and their mean EuroSCORE II was 1.1. Median ICU and hospital stay was 1 and 3 days, respectively. All procedures were uneventful and there were no major complications. Successful repair, resulting in trace or mild mitral regurgitation, was achieved in all 8 patients, by implantation of 2 to 4 neochordae. At 3 to 5 months follow-up, 7patients presented trace to mild mitral regurgitation, while 1 patient had moderate mitral regurgitation due to extreme left ventricular volume reduction. There was a trend towards left ventricular reverse remodeling in all patients, with reduction of indexed left ventricle end diastolic volume. All patients were in NYHA class I or II and there was no need of reintervention, so far. </p> <p>In select patients, mitral valve repair using the NeoChord DS1000™ system, which allows both implantation and later lenght adjustment of artificial chordae, is safe, effective and reproducible.</p>
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