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• W3212607071 abstract "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. The authors aim to analyze short-term clinical and echocardiographic results after mitral valve repair using the NeoChord™ system. 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). 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 cm2, 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/m2 vs. 45±6 mL/m2, p=0.038), mean indexed left ventricular end-diastolic volume (87±7 mL/m2 vs. 79±9 ml/m2, 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. 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. A implantação de neocordas por via transapical sem circulação extracorporal é uma técnica minimamente invasiva de reparação valvular mitral (RVM). É utilizada no tratamento de insuficiência mitral (IM) degenerativa, com recurso ao dispositivo NeoChord DS1000™. O procedimento é realizado sob orientação de ecocardiografia transesofáfica (ETE) 2D e 3D e demonstrou ser seguro e eficaz em doentes cuidadosamente selecionados. Os autores pretendem analisar os resultados clínicos e ecocardiográficos a curto prazo da RVM minimamente invasiva com o sistema NeoChord™. Foram incluídos todos os doentes submetidos a RVM com implantação de neocordas por via transapical no nosso centro, entre dezembro de 2017 e dezembro de 2019. O procedimento foi realizado por minitoracotomia esquerda, sob anestesia geral. Todos os doentes apresentaram IM primária grave por flail ou prolapso de um dos folhetos da válvula mitral. Dezoito doentes foram incluídos na análise, com uma idade média de 65±15 anos, 72% do sexo masculino. O score EuroSCORE II médio foi 1,9±1,6. Todos os doentes tinham classe funcional NYHA ≥ II. O EROA médio foi de 1,0±0,4 cm2, com um volume regurgitante médio de 146±42 mL e um índice folheto-anel de 1,29±0,14. A causa da IM foi prolapso de um dos folhetos em 50% dos doentes (N=9) e flail de um dos folhetos em 50% (N=9). O tipo anatómico A (defeito isolado de P2) foi a forma predominante, em 66,5% dos casos (N=12). O sucesso do procedimento, definido por IM mínima ou ligeira com implantação de 2 a 4 neocordas, foi atingido em todos os doentes. Não se registaram complicações major intraprocedimento. O follow-up (F-UP) médio foi de 194 dias. A classe de NYHA foi ≤ II em 94,5% dos doentes aos seis meses de F-UP, representando uma melhoria significativa comparativamente à classe funcional basal (p=0,002). Ao longo do F-UP, 72% dos doentes (N=13) mantiveram IM grau ≤ II. Verificou-se uma redução significativa no volume auricular esquerdo (63±7 mL/m2 versus 45±6 mL/m2, p=0,038), volume telediastólico do ventrículo esquerdo (87±7 mL/m2 versus 79±9 ml/m2, p=0,001) e da PSAP (44±4 versus 31±8 mmHg, p=0,002). A taxa de reintervenção foi de 11,1% (N=2, um dos doentes tendo sido submetido a re-do NeoChord™ e outro a cirurgia convencional de RVM). Não foram registados eventos adversos major cardio ou cerebrovasculares. Em doentes selecionados, a RVM minimamente invasiva com recurso ao sistema NeoChord™ revelou-se segura, efetiva e reprodutível. Os resultados clínicos e ecocardiográficos a curto prazo sugerem uma melhoria sintomática significativa, redução sustentada do grau de IM e remodelagem favorável das câmaras cardíacas esquerdas, com uma taxa reduzida de reintervenção. Estes resultados merecem confirmação ulterior em coortes maiores de doentes e ao longo de um follow-up mais prolongado." @default.
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• W3212607071 date "2021-11-01" @default.
• W3212607071 modified "2023-10-18" @default.
• W3212607071 title "Transapical off-pump mitral valve repair with NeoChord™ implantation: An early single-center Portuguese experience" @default.
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• W3212607071 doi "https://doi.org/10.1016/j.repc.2021.01.016" @default.
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