094 * OFF-PUMP TRANSAPICAL MITRAL VALVE REPAIR WITH NEOCHORDAE

Abstract

Objectives: On-pump mitral valve repair is well established and currently the gold standard. Off-pump mitral valve repair has so far not been feasible. Based on improved online cardiac imaging techniques such as 3D echocardiography, a closed application technique of neochordae in prolapsed leaflet segments with a newly developed device, Neochord DS 1000, has been developed. We present our experience with this technique in 8 patients with mitral valve prolapse. Methods: Eight patients, age 60 ± 12.8 years, 5 male, presented with severe mitral regurgitation with mitral valve (MV) prolapse of the posterior mitral leaflet, left ventricular ejection fraction 51.6 ± 7.4%, pulmonary arterial pressure 52.5 ± 20.3 (40–100) mmHg, atrial fibrillation in 2 patients, left atrial diameter 47.1 ± 3.3 mm, left ventricular end diastolic diameter 61.9 ± 8.3 mm, AP diameter (MV) 41.9 ± 1.45 mm. Surgery was performed via left mini-thoracotomy (5th intercostal space, medioclavicular line). The chordal implantation tool was inserted 2D/3D guided under heparin (activated clotting time >300 s) through the ventricular apex laterally on beating heart. Under sophisticated 2D/3D echo-guidance, the artificial chordae (GoreTex 4-0) were placed with the Neochord DS 1000 System; the number of neochordae was 3 in 6 patients and 4 in 2 patients. Adjustment was done under continuous 2D/3D echo-control. Results: There were no operative complications and no blood transfusions. Residual MI was zero in 5, trace in 2 and I–II in 1 patient. All patients were extubated within 3 h. Echo at discharge as well as at follow-up (4.1 ± 1.9 months) was stable except for one patient with increase of MI due to ventricular remodelling. Conclusion: Off-pump minimal invasive mitral valve repair with artificial chordae is feasible with excellent short-term results. Long-term observation is neccessary to confirm durability.