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• W3037965921 abstract "Central MessageOff-pump transapical mitral neo-chord implantation is still in a developing stage. Basic experimental research is fundamental to improve clinical results.See Article page 27. Off-pump transapical mitral neo-chord implantation is still in a developing stage. Basic experimental research is fundamental to improve clinical results. See Article page 27. Mitral valve repair is the standard-of-care treatment for patients with leaflet prolapse and severe valvular regurgitation secondary to fibroelastic deficiency or myxomatous degenerative disease. To obtain a successful and durable result, multiple resectional and nonresectional surgical maneuvers must be individually applied at cusp, chordae, papillary muscle, and annular levels to address a wide variety of anatomical lesions responsible for valve dysfunction.1El-Eshmawi A. Castillo J.G. Tang G.H.L. Adams D.H. Developing a mitral valve center of excellence.Curr Opin Cardiol. 2018; 33: 155-161Crossref PubMed Scopus (11) Google Scholar In combination with other maneuvers, the use of expanded polytetrafluoroethylene sutures to correct leaflet prolapse and reinforce regions supported by thin and fragile native chordae tendineae has proved to be an effective and durable technique to obtain a competent valve.2David T.E. David C.M. Tsang W. Lafreniere-Roula M. Manlhiot C. Long-term results of mitral valve repair for regurgitation due to leaflet prolapse.J Am Coll Cardiol. 2019; 74: 1044-1053Crossref PubMed Scopus (40) Google Scholar However, adjusting for proper neochordae length may be not so simple as originally thought, and several different methods for accomplishing the ideal length have been proposed. The tedious and elegant computational model of Caballero and colleagues3Caballero A. McKay R. Sun W. Computer simulations of transapical mitral valve repair with neochordae implantation: clinical implications.J Thorac Cardiovas Surg Open. 2020; 3: 27-44Google Scholar published in this issue of the JTCVS Open sheds light and demonstrates in a rigorous scientific way that minor variations during neochordae implantation such as length, position, angulation, and number of implanted chords can induce significant augmented neochordae tension and leaflet stress that may be responsible for late failures despite an apparent favorable initial result. Although their original intention was to provide an improved understanding of biomechanical forces after transapical off-pump neochordae implantation, the data and concepts also have important implications during open repairs, be it through sternotomy, minimally invasive, or robotic approaches. Mitral valve repair, when performed by experienced surgeons, can be performed with very low operative mortality, low recurrence rates, and excellent long-term survival.2David T.E. David C.M. Tsang W. Lafreniere-Roula M. Manlhiot C. Long-term results of mitral valve repair for regurgitation due to leaflet prolapse.J Am Coll Cardiol. 2019; 74: 1044-1053Crossref PubMed Scopus (40) Google Scholar However, most series do not include a significant proportion of elderly and fragile patients with multiple comorbidities. Patients with this profile are frequently denied surgery and often left in medical treatment alone. Although currently it is difficult to justify an off-pump transapical approach for low- and intermediate-risk patients, a less-invasive procedure may be a reasonable option in selected high-risk or inoperable patients. Although initial experience with alternative procedures such as MitraClip and off-pump neochordae implantation has been associated with greater incidences of persistent and recurrent mitral regurgitation, they may well represent an adequate palliation in otherwise-inoperable patients.4Colli A. Manzan E. Aidietis A. Rucinskas K. Bizzotto E. Besola L. et al.An early European experience with transapical off-pump mitral valve repair with NeoChord implantation.Eur J Cardiothorac Surg. 2018; 54: 460-466Crossref PubMed Scopus (68) Google Scholar Meanwhile, basic research work such as that presented by Caballero and colleagues will be fundamental to improve new technologies that should be carefully evaluated in proper designed clinical trials before being applied in a more generalized way. Computer simulations of transapical mitral valve repair with neochordae implantation: Clinical implicationsJTCVS OpenVol. 3PreviewTransapical beating heart neochordae implantation is an innovative mitral valve repair technique that has demonstrated promising clinical results in patients with primary mitral regurgitation. However, as clinical experience continues to increase, neochordae implantation criteria have not been fully standardized. The aim of this study was to investigate the biomechanical effects of selecting an antero-lateral apical access site compared with a postero-lateral site, and suboptimal neochordae length compared with optimal suture length, on restoring physiologic left heart dynamics. Full-Text PDF Open Access" @default.
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• W3037965921 date "2020-09-01" @default.
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• W3037965921 title "Commentary: Mitral valve neo-chords, still a lot to learn!" @default.
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• W3037965921 doi "https://doi.org/10.1016/j.xjon.2020.06.009" @default.
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