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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 NeoChord implantation: Early clinical and echocardiographic results
Session:
Prémio Manuel Machado Macedo – CE MMM/SPC
Speaker:
Pedro Miguel Gonçalves Teixeira
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.10 Cardiovascular Surgery – Minimally Invasive Surgery
Session Type:
Prémios
FP Number:
---
Authors:
Pedro Gonçalves Teixeira; Sara Simões Costa; João Pedro Monteiro; Tiago Millner; Joana Rei; Daniel Martins; Paulo Neves; José Ribeiro
Abstract
<p>INTRODUCTION: Transapical off-pump NeoChord implantation is a minimally invasive surgical mitral valve repair (MVr) procedure to treat degenerative mitral regurgitation (MR), which is performed using the NeoChord DS1000® system under 2D and 3D transesophageal echocardiographic (TEE) guidance on a beating heart, and has been demonstrated to be safe and effective in carefully selected patients.</p> <p>OBJECTIVE: The authors aim to analyze short-term clinical and echocardiographic results after mitral valve repair using the NeoChord system.</p> <p>METHODS: All patients that underwent transapical off-pump mitral valve repair with NeoChord implantation in our center, between December 2017 and October 2019, were included. The procedure was performed by left minithoracotomy, under general anaesthesia, using 2D and 3D TEE guidance. All patients presented with severe primary MR due to flail/prolapse of one leaflet (anterior or posterior).</p> <p>RESULTS: Eighteen patients were included in the analysis, the mean age was 65 ± 15 years, 72% were male. The mean EuroSCORE II was 1.9 ± 1.6. The prevalence of AF was 16.7%. Patients had NYHA class ≥II in 77.8% of cases (N=14).</p> <p>Mean EROA was 1.0 ± 0.4 cm<sup>2</sup>, with a mean RVol 146 ± 42 mL, and a mean Leaflet-to-Annulus index of 1.29 ± 0.14. MR was due to leaflet prolapse in 50% (N=9), and flail leaflet in 50% (N=9). Anatomic type A (isolated P2 defect) was the predominant form, in 66.7% (N=12).</p> <p>Successful repair, defined by none, trace or mild mitral regurgitation, by implantation of 2 to 4 neochordae, was achieved in all 18 patients. No major complications arose intra-procedurally. Median ICU stay was 1 day (IQR 0.5).</p> <p>The median follow-up (F-UP) was 194 days. NYHA class was ≤II in all patients, which represented a significant improvement in symptomatic status (p=0.002). MR was quantified in grade ≤II in 88.2% (N=15) patients by the time of discharge. In F-UP, 3 patients had grade III MR, and 2 patients had grade IV MR.</p> <p>There was a significant reduction in mean indexed LA volume (63±7 mL/m2 pre-procedure, compared to 35±6 mL/m2 in F-UP, p=0.038), mean indexed LV end-diastolic volume (87±7 mL/m2 vs 79±9 ml/m2, p=0.001), and PSAP (44±4 vs 31±8 mmHg, p=0.002); with no significant differences regarding tricuspid regurgitation severity or LV systolic function.</p> <p>The re-intervention rate was 11.1% (N=2, both patients being submitted to a re-do Neochord, either with new chord attachment and/or re-tensioning). No major adverse cardiac or cerebrovascular events were registered.</p> <p>CONCLUSIONS: In selected patients, minimally invasive MVr using the NeoChord system, is safe, effective and reproducible. Early clinical and echocardiographic results suggest a significant symptomatic improvement, sustained MR grade decrease, and favourable left cardiac chambers’ remodelling, with low re-intervention rates. These results warrant further confirmation in larger cohorts, over a longer follow-up period.</p>
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