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Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair? [Anatol J Cardiol]
Anatol J Cardiol. 2019; 22(6): 319-324 | DOI: 10.14744/AnatolJCardiol.2019.17055  

Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair?

Salih Salihi1, Bilhan Özalp1, Hakan Saçlı1, İbrahim Kara1, Cengiz Köksal2
1Department of Cardiovascular Surgery, Sakarya University Training and Research Hospital; Sakarya-Turkey
2Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakıf University; İstanbul-Turkey

Objective: Trans-apical off-pump mitral valve repair is a new minimally invasive surgical technique for the correction of mitral regurgitation caused by mitral leaflet prolapse. The purpose of this study is to evaluate, using clinical and echocardiographic follow-up data, the mid-term results of patients undergoing this procedure.
Methods: A total of 26 patients diagnosed with severe mitral regurgitation underwent mitral valve repair with trans-apical off-pump neochord implantation using the NeoChord device at our hospital from July 2015 to July 2017. All patients were examined by transthoracic and transesophageal echocardiography. Eighteen (69.2%) patients had type A anatomy, 4 (15.4%) had type B anatomy, and 4 (15.4%) had type C anatomy. Preoperative, intraoperative, and postoperative demographic, echocardiographic, and clinical data were collected.
Results: The patients’ age ranged from 33 to 76 years (mean: 56±10.1 years). The average preoperative EuroSCORE II was 1.04%±0.7%. Acute procedural success was achieved in 25 (96.15%) patients. There was only 1 early death (30-day mortality rate: 3.8%) due to postoperative low cardiac output syndrome. Transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation in 87.5% of the patients and moderate regurgitation in 12.5% of the patients. During the follow-up period, transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation (MR) in 14 (58.3%) patients. Six (25%) patients presented with moderate MR and 4 (16.7%) patients had severe MR. At the 30-month follow-up, freedom from residual severe MR was 78.8%±10.3% and freedom from reoperation was 87.5%±6.8%.
Conclusion: Trans-apical off-pump mitral valve repair with neochord implantation may be a suitable treatment option in patients with isolated posterior mitral valve leaflet prolapse.

Keywords: mitral regurgitation, mitral valve prolapse, neochord


Salih Salihi, Bilhan Özalp, Hakan Saçlı, İbrahim Kara, Cengiz Köksal. Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair?. Anatol J Cardiol. 2019; 22(6): 319-324

Corresponding Author: Cengiz Köksal, Türkiye


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