PMID- 34922700
OWN - NLM
STAT- MEDLINE
DCOM- 20211228
LR  - 20211228
IS  - 2174-2049 (Electronic)
IS  - 2174-2049 (Linking)
VI  - 40
IP  - 12
DP  - 2021 Dec
TI  - Transapical off-pump mitral valve repair with NeoChord implantation: An early 
      single-center Portuguese experience.
PG  - 933-941
LID - S2174-2049(21)00364-0 [pii]
LID - 10.1016/j.repce.2021.11.011 [doi]
AB  - INTRODUCTION: Transapical off-pump NeoChord DS1000 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 
      with two and three-dimensional transesophageal echocardiographic guidance on a 
      beating heart. It has been demonstrated to be safe and effective in carefully 
      selected patients. OBJECTIVE: The authors aim to analyze short-term clinical and 
      echocardiographic results after mitral valve repair using the NeoChord system. 
      METHODS: All patients that underwent transapical off-pump mitral valve repair 
      with NeoChord implantation at our center, between December 2017 and December 
      2019, were included. The procedure was performed by left minithoracotomy, under 
      general anesthesia. All patients presented severe primary MR due to 
      flail/prolapse of one leaflet (anterior or posterior). 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. All patients had New York Heart Association (NYHA) 
      class >/= II. Mean effective regurgitant orifice area was 1.0+/-0.4 cm(2), with a 
      mean regurgitant volume 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 66.5% 
      (N=12). Successful repair, defined by none, trace or mild mitral regurgitation, 
      by implantation of two to four neochordae, was achieved in all 18 patients. No 
      major complications arose intra-procedurally. The median follow-up was 194 days. 
      NYHA class was </=II in 94.5% patients at six-month follow-up, which represented a 
      significant improvement in symptomatic status (p=0.002). At follow-up, 72% of 
      patients (N=13) had grade </=2 MR. There was a significant reduction in mean 
      indexed left atrium volume (63+/-7 mL/m(2) vs. 45+/-6 mL/m(2), p=0.038), mean indexed 
      left ventricular end-diastolic volume (87+/-7 mL/m(2) vs. 79+/-9 ml/m(2), p=0.001), 
      and pulmonary arterial systolic pressure (44+/-4 vs. 31+/-8 mmHg, p=0.002). The 
      re-intervention rate was 11.1% (N=2, both patients underwent reintervention, 
      either a re-do NeoChord or conventional MV repair on-pump surgery). No major 
      adverse cardiac or cerebrovascular events were registered. 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 favorable 
      left cardiac chamber remodeling, with low re-intervention rates. These results 
      warrant further confirmation in larger cohorts, on longer period of follow-up.
CI  - Copyright (c) 2021 Sociedade Portuguesa de Cardiologia. Published by Elsevier 
      Espana, S.L.U. All rights reserved.
FAU - Goncalves-Teixeira, Pedro
AU  - Goncalves-Teixeira P
AD  - Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal; 
      Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 
      Porto, Portugal. Electronic address: pedromgoncalvesteixeira@gmail.com.
FAU - Costa, Sara
AU  - Costa S
AD  - Cardiothoracic Surgery Department, Gaia Hospital Center, Vila Nova de Gaia, 
      Portugal.
FAU - Martins, Daniel
AU  - Martins D
AD  - Cardiothoracic Surgery Department, Gaia Hospital Center, Vila Nova de Gaia, 
      Portugal.
FAU - Neves, Paulo
AU  - Neves P
AD  - Cardiothoracic Surgery Department, Gaia Hospital Center, Vila Nova de Gaia, 
      Portugal.
FAU - Ribeiro, Jose
AU  - Ribeiro J
AD  - Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal.
LA  - eng
PT  - Journal Article
PL  - Spain
TA  - Rev Port Cardiol (Engl Ed)
JT  - Revista portuguesa de cardiologia
JID - 101770878
SB  - IM
CIN - Rev Port Cardiol (Engl Ed). 2021 Dec;40(12):943-945. PMID: 34922701
MH  - Aged
MH  - Aged, 80 and over
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/diagnostic imaging/surgery
MH  - *Mitral Valve Insufficiency/surgery
MH  - Portugal
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Cirurgia minimamente invasiva
OT  - Minimally invasive
OT  - Mitral valve repair
OT  - NeoChord
OT  - Neochord
OT  - Reparacao valvular mitral
EDAT- 2021/12/20 06:00
MHDA- 2021/12/29 06:00
CRDT- 2021/12/19 20:36
PHST- 2020/08/14 00:00 [received]
PHST- 2021/01/18 00:00 [accepted]
PHST- 2021/12/19 20:36 [entrez]
PHST- 2021/12/20 06:00 [pubmed]
PHST- 2021/12/29 06:00 [medline]
AID - S2174-2049(21)00364-0 [pii]
AID - 10.1016/j.repce.2021.11.011 [doi]
PST - ppublish
SO  - Rev Port Cardiol (Engl Ed). 2021 Dec;40(12):933-941. doi: 
      10.1016/j.repce.2021.11.011.