Off-pump Transapical Implantation of Artificial Chordae: Echo Data, Results, and Follow-up in 24 Patients

Objectives: The aim of this study was to evaluate the safety and efficiency of transapical implantation of artificial chordae as a possible opportunity in treating patients with severe primary mitral regurgitation (MR) and to connect the preoperative echocardiographic data with the outcome of the procedure.

Methods: Twenty-four patients suffering from severe MR higher than grade III due to posterior leaflet prolapse underwent an off-pump transapical mitral valve reconstruction method using the NeoChord DS1000 Device. Through an anterolateral thoracotomy, the device was inserted transapically into the heart reaching the mitral valve. The prolapsed parts were grasped and fixed at the ventricle by implanting artificial chords. The procedure was performed under general anesthesia and guided by 3D transesophageal echocardiography.

Results: In 8 (33.3%) of 24 patients, MR could be successfully reduced to grades 0 to I as observed by echocardiography. Twelve patients (50%) showed a mild MR grades I to II, three patients (12.5%) had a remaining MR grades II to III, and one patient (4.2%) persists at MR grade III. A total of six patients (25%) had recurrent mitral regurgitation: One patient within 1 month, three patients within 5 months, and two patients within more than 15 months. Those patients underwent further mitral intervention. Two patients (8.3%) died from postoperative complications. In consideration of preoperative echocardiographic data, no predictive parameters could be identified correlating with the outcome. Average operation time was 148 (±24) minutes. In most patients (62.5%), three chordae were implanted. In four patients, hematoma in the region of the ventriculotomy was observed. Even first occurred atrial fibrillation (n = 4), postoperative delirium (n = 4), and elevated infectious parameters (n = 4) were the most frequent postoperative complications.

Conclusion: Our preliminary results with 24 patients show that severe MR could be successfully corrected using the NeoChord DS1000 system. Longer follow-up data are needed to confirm the initially positive outcome. In accordance to previous studies, the used approach is safe, feasible and has a relatively short procedure time indicating it being a promising technique for treating patients with severe primary MR. Predictive echo data have to be defined by evaluating a possible correlation with patients’ outcome in a much more larger population.

No conflict of interest has been declared by the author(s).