Mid-term follow up of transcatheter echo guided mitral valve repair with neochordae implantation

Abstract

Abstract Background Transapical off-pump mitral valve repair with neochordae implantation has become as a promising alternative to conventional surgery for patients with severe mitral regurgitation (MR) due to posterior leaflet prolapse or flail (PML). We present our single center mid-term results about safety and efficacy of this innovative, minimally invasive mitral valve repair approach. Methods Symptomatic patients with severe MR secondary to PML flail/prolapse (March 2017-Jan 2021) that underwent the NeoChord procedure were included. Patients were stratified according of the preoperative 3D-TEE assessment of MV morphology: Type A, isolated central PML prolapse/flail; Type B, posterior multisegment prolapse/flail; Type C and D, anterior or bileaflet prolapse/flail or paracommissural prolapse/flail or any type of disease with the presence of significant leaflet/annular calcification. Type A was considered the more favorable morphology. Clinical and echocardiographic follow-up at one, three, six, twelve months and yearly were performed. Results 43 patients were included; median follow-up was 19 (IQR 13–23) months. Median age was 67.7±13.4 y. Median EuroSCOREII 2.7%±1.91. There were 35 Type A patients (81.4%), 4 Type B (9.3%), 1 Type C (2.3%), and 3 Type D (7%). Procedural success was achieved in 38 patients (88,4%). 5 patients, 2 type A and 3 type D, underwent conversion to open surgery for immediate failure. One high-risk patient considered inoperable died before discharge. Postoperative length of stay was 4.25±1 days. At 19 (IQR 13–23) months median followup, MR≤ II was present in 29 (76.3%). Overall 2 year survival was 100%. Freedom from reintervention was 89% for overall population. 86.84% were in New York Heart Association class I. Conclusions NeoChord procedure is a feasible, low risk technique that allows safely repair degenerative MR and demonstrated good clinical outcomes and echocardiographic results at mid-term follow-up. Funding Acknowledgement Type of funding sources: None.