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RF55 OFF PUMP MITRAL VALVE REPAIR WITH NEOCHORD SYSTEM: FROM PIONEERING TO CLINICAL PRACTICE

Background and aim: Transapical off-pump mitral valve intervention with neochordae implantation is a novel, minimally invasive procedure for treatment of degenerative mitral valve regurgitation. The aim of this study is to describe our initial experience with this new technique and to describe the tip and tricks to improve the results. Methods: Patients were selected for NeoChord repair when Leaflet-to-Annulus Index (LAI) (defined as the ratio between the sum of anterior leaflet length (AML) and posterior leaflet length (PML) over antero-posterior length) was > 2 and mitral annulus inferior to 40 mm. Measurements were performed with 2D and 3D transesophageal echocardiography. Results: Between 2015 and 2018, at Salus Hospital and Maria Cecilia Hospital, a total of 35 patients were treated, (median age of 68 years and median EuroSCORE of 5.33). The majority of them (95%) presented a posterior leaflet prolapse, 2.5% with an anterior leaflet prolapse and 2.5% with a combined. Early procedural success was achieved in all patients.Two neochordae were implanted in 8 patients (22.85%), 3 in 17 (48.55%), 4 in 4 (11.45%), 5 in 4 (11.45%), 6 in 2 (5.7 %). During surgery a mean of 3.2 Couple of chordae were used. All intraoperative data and postoperative outcomes, in terms of intensive care unit stay, blood loss, transfusions have been analysed as well the echocardiography at discharge was analyzed. Conclusions: NeoChord repair is a safe procedure, and the early results are impressive. Our data are encouraging but for sure long term follow up and a correct patients selection are essential.