Beating Heart Mitral Valve Repair for Severe Degenerative Mitral Regurgitation: Single-Center First Experience.
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP006
Submission Type:
Abstract Submission
Authors:
Romy Hegeman (1), Thom de Kroon (1), Martin Swaans (1), Patrick Klein (1)
Institutions:
(1) Sint Antonius Hospital, Nieuwegein, Utrecht
Submitting Author:
Romy Hegeman
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Sint Antonius Hospital
Sint Antonius Hospital
Co-Author(s):
Thom de Kroon
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Sint Antonius Hospital
Sint Antonius Hospital
Martin Swaans
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Sint Antonius Hospital
Sint Antonius Hospital
Patrick Klein
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Sint Antonius Hospital
Sint Antonius Hospital
Presenting Author:
Romy Hegeman
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Abstract:
Objective: Conventional mitral valve repair for degenerative mitral regurgitation (MR) requires cardiopulmonary bypass, aortic cross-clamping, cardioplegia and a thoracotomy or sternotomy. We report the outcome of our single-center first experience with transapical Beating Heart Mitral Valve Repair (BHMVR) with a novel device. Transapical BHMVR enables transoesophageal echo-guided implantation of artificial expanded polytetrafluoroethylene (ePTFE) chords on the beating heart. This minimally invasive surgical procedure is intended for anatomical mitral valve repair in patients with severe degenerative MR caused by posterior mitral valve prolapse.
Methods: A single-center prospective evaluation of transapical BHMVR for symptomatic severe degenerative MR with suitable anatomy was performed. Procedural suitability was based on isolated prolapse of the middle scallop of the posterior mitral valve leaflet (scallop P2), sufficient tissue-to-gap ratio and ample concavity of the prolapsing scallop. Procedural success was defined as successful valvular repair with ≤ mild residual MR and sufficient leaflet coaptation. Echocardiographic and clinical outcome was evaluated.
Results: Eight patients (mean age 75 ± 6 years) underwent transapical BHMVR in our center between July 2021 and November 2022. Three to five ePTFE chords were needed to correct mitral valve dysfunction. Procedural success was 88% (7 patients); one patient was converted to port-access mitral replacement because of pull-out of the ePTFE chords from the posterior mitral leaflet. Coaptation was 6 ± 2 mm after repair. Mean procedural time was 107 ± 25 minutes. Residual MR was ≤ mild in all patients at discharge. There was no hospital mortality or morbidity. Patients were discharged after a mean stay of 5 ± 2 days. During 1-year follow-up, two patients showed more than moderate recurrent MR for which re-intervention with additional ePTFE chord implantation or re-tensioning of the implanted chords was performed.
Conclusions: For the first time reporting single-center outcome, we show that transapical BHMVR with a novel device is feasible for correction of degenerative MR, with high initial procedural success and short duration of hospital stay. Based on this small series, recurrence of MR at early follow-up appears to be higher compared to conventional mitral repair. However, correction can be accomplished through the same minimally invasive approach by adding or re-tensioning the ePTFE chords.
Methods: A single-center prospective evaluation of transapical BHMVR for symptomatic severe degenerative MR with suitable anatomy was performed. Procedural suitability was based on isolated prolapse of the middle scallop of the posterior mitral valve leaflet (scallop P2), sufficient tissue-to-gap ratio and ample concavity of the prolapsing scallop. Procedural success was defined as successful valvular repair with ≤ mild residual MR and sufficient leaflet coaptation. Echocardiographic and clinical outcome was evaluated.
Results: Eight patients (mean age 75 ± 6 years) underwent transapical BHMVR in our center between July 2021 and November 2022. Three to five ePTFE chords were needed to correct mitral valve dysfunction. Procedural success was 88% (7 patients); one patient was converted to port-access mitral replacement because of pull-out of the ePTFE chords from the posterior mitral leaflet. Coaptation was 6 ± 2 mm after repair. Mean procedural time was 107 ± 25 minutes. Residual MR was ≤ mild in all patients at discharge. There was no hospital mortality or morbidity. Patients were discharged after a mean stay of 5 ± 2 days. During 1-year follow-up, two patients showed more than moderate recurrent MR for which re-intervention with additional ePTFE chord implantation or re-tensioning of the implanted chords was performed.
Conclusions: For the first time reporting single-center outcome, we show that transapical BHMVR with a novel device is feasible for correction of degenerative MR, with high initial procedural success and short duration of hospital stay. Based on this small series, recurrence of MR at early follow-up appears to be higher compared to conventional mitral repair. However, correction can be accomplished through the same minimally invasive approach by adding or re-tensioning the ePTFE chords.
Mitral Conclave:
Minimally Invasive & Robotic Mitral Valve Repair
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