Transapical Off-Pump Neochord Alone versus Combined Neochord/Transcatheter Repair for Mitral Valve Regurgitation

Objectives: Transapical off-pump Neochord repair is a novel minimally invasive surgical procedure to treat degenerative mitral valve regurgitation (DMR). DMR patients scheduled for Neochord are classified in Type A: isolated central posterior leaflet disease; Type B: posterior multisegment disease; and Type C: anterior, bileaflet, paracommissural disease, and/or calcifications. Outcomes depend on the anatomical defect, and sometimes combined transcatheter procedures are needed to correct DMR. Our aim was to evaluate the perioperative outcomes of Neochord procedure alone versus Neochord plus other transcatheter procedure in a consecutive cohort of patients.

Methods: The first 24 consecutive patients who underwent Neochord (NeoChord Inc., United States) repair at our institution between February 2017 and May 2018 (15 months) were analyzed. Demographic variables, type of DMR according to the anatomical classification, as well as intraoperative data were evaluated. Procedural success was measured through the difference between baseline MR and postprocedural MR (delta-MR). All cases were divided in two groups (Neochord: n = 13; combined: n = 11).

Results: Combined procedures with Neochord included percutaneous annuloplasty with Carillon Mitral Contour System (Cardiac Dimensions, United States; n = 4) or Cardioband (Edwards Lifesciences; n = 2) or Edge-to-Edge repair with MitraClip (Abbott Vascular; n = 5). The mean age differed between both groups, being patients undergoing combined procedure significantly older (77 ± 8 vs. 69 ± 10; p < 0.05). Procedural times were longer in the combined cases, which were performed in patients with more complex mitral pathology (Type C, p < 0.05). Procedural success was achieved in 96% of the patients, and interestingly, both the postprocedural MR and the difference to baseline were significantly better in the more favorable anatomical type treated with Neochord alone (ΔMR: 3.5 ± 0.4 vs. 3.1 ± 0.4; p < 0.05).

Conclusion: These results demonstrate that the Neochord procedure is safe and effective, both alone and in combined procedures for complex MV repair in an off-pump, minimally invasive manner.

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