Echocardiographic and clinical outcomes following beating heart NeoChord DS1000 mitral valve repair: a single centre case series

MP017 

Abstract Submission 

Hallie Jefferson (1), Amy Brown (1), Ali Fatehi Hassanabad (2), Christopher Noss (3), Nicole Webb (3), Paul Fedak (4), William Kent (4), Corey Adams (4)

(1) University of Calgary, Calgary, Alberta, (2) University of Calgary, Canada, Alberta, (3) Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, (4) Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta

Hallie Jefferson    -  Contact Me
University of Calgary

Amy Brown    -  Contact Me
University of Calgary

Ali Fatehi Hassanabad    -  Contact Me
University of Calgary

Christopher Noss    -  Contact Me
Department of Anesthesiology, Cumming School of Medicine, University of Calgary

Nicole Webb    -  Contact Me
Department of Anesthesiology, Cumming School of Medicine, University of Calgary

*Paul Fedak    -  Contact Me
Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary

William Kent    -  Contact Me
Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary

Corey Adams    -  Contact Me
Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary

Hallie Jefferson    -  Contact Me
N/A

Objectives: The NeoChord DS1000 system is an innovative device that implants neochords transapically, through a left mini-thoracotomy to treat mitral valve regurgitation (MR) without cardiopulmonary bypass. NeoChord implantation and length adjustment is performed under transesophageal echocardiographic guidance and beating heart conditions. We describe our experience with the Neochord system in moderate to high risk patients with degenerative MR using an "over-tensioning" strategy to account for LV reverse remodeling over time.

Methods: In this prospective series, all study patients had degenerative MR and were considered for conventional mitral valve surgery but were moderate to high-risk. Eligibility for NeoChord was based on echocardiographic criteria, including isolated posterior leaflet prolapse, leaflet to annulus index greater than 1.2, and coaptation length index greater than 5mm. Patients with multi-leaflet pathology, mitral annular calcification, and ischemic MR were excluded.

Results: Ten patients underwent the procedure; 6 male and 4 female with mean age of 76 years. All patients had severe chronic MR. Two of ten patients had prior MV repair with annuloplasty. NeoChord was successfully implanted transapically in 9 of 10 patients. One patient required conversion to an open procedure due to leaflet injury. The average number of NeoChord sets was 3 (+/- 1.49). Immediate post-procedure degree of MR on echocardiography ranged from trivial to mild, and on postoperative day 1 from trivial to moderate (N=2). Average length of coaptation was 0.85±0.21cm and average depth of coaptation was 0.72±0.15cm. Post-operative MR on echocardiography was least in those with prior annuloplasty with (trace-mild) compared to those without (mild-moderate). One month follow up of MR ranged from trivial to moderate and left ventricular inner diameter dimensions decreased from an average of 5.3 cm to 4.5 cm. No patients with successful NeoChord implantation required blood products. Half or 50% of patients were discharged in less than 3 days. There was 1 perioperative stroke with no residual deficits. At 30-days post-procedure no patients were readmitted or had died.

Conclusions: We report the first Canadian experience with NeoChord DS1000 for off-pump, transapical, beating heart mitral valve repair, through a left mini-thoracotomy. Based on our initial results Neochord is safe and effective, and may be best for patients with recurrent MR and prior annuloplasty.

Minimally Invasive & Robotic Mitral Valve Repair