Preoperative TEE analysis and its predictive value in patients undergoing beating heart mitral valve repair.

MP047 

Abstract Submission 

Ferdinand Vogt (1), Ann Sophie Schorn (2), Stephan von Bardeleben (3), Tobias Ruf (4), Helmut Mair (4), Holger Schroefel (5), Nicolas Doll (6), Theodor (Teddy) Fischlein (7), Francesco Pollari (8)

(1) Klinikum Nürnberg, Nuremberg, Germany, Nuremberg, Bavaria, (2) Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany, Mainz, NA, (3) Mainz Valve Center, Mainz, Germany, (4) N/A, N/A, (5) Clinic for Cardiac, Thoracic and Vascular Surgery, Heart Centre Lahr, Lahr, Germany, Lahr, NA, (6) Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany, Bad Rothenfelde, NA, (7) Klinikum Nürnberg, Nuremberg, Bavaria, (8) Klinikum Nürnberg, Nuremberg, Bayern

Ferdinand Vogt    -  Contact Me
Klinikum Nürnberg, Nuremberg, Germany

Ann Sophie Schorn    -  Contact Me
Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany

Stephan von Bardeleben    -  Contact Me
Mainz Valve Center

Tobias Ruf    -  Contact Me
N/A

Helmut Mair    -  Contact Me
N/A

Holger Schroefel    -  Contact Me
Clinic for Cardiac, Thoracic and Vascular Surgery, Heart Centre Lahr, Lahr, Germany

Nicolas Doll    -  Contact Me
Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany

*Theodor (Teddy) Fischlein    -  Contact Me
Klinikum Nürnberg

Francesco Pollari    -  Contact Me
Klinikum Nürnberg

Ferdinand Vogt    -  Contact Me
Klinikum Nürnberg, Nuremberg, Germany

Objective:
Transapical NeoChord mitral valve repair (MVR) is a novel minimal-invasive procedure to treat primary mitral regurgitation (MR) without concomitant annuloplasty. Systematic preoperative calculation of leaflet-to-annulus index (LAI) and coaptation index (CI) using transesophageal echocardiography (TEE) has been identified as a prognostic predictor of outcomes at follow-up. This study aims to correlate the predictive value of preoperative assessment and proctor review with the success of the NeoChord procedure.
Methods:
Patients with prolapse/flail of the posterior mitral leaflet scheduled for NeoChord MVR underwent preoperative TEE analysis. TEE analysis was performed using 3mensio software (3mensio, Pie Medical Imaging, Maastricht, The Netherlands). Different parameters, including predictive indexes like LAI and CI, systolic pulmonary artery pressure, indexed left ventricle end-systolic volume (iLVESV), prolapse/flail width (FW), systolic antero-posterior (AP) annulus diameter, systolic latero-lateral (LL) annulus diameter and presence of calcification were analysed. A proctor predicted the results of the procedure based on the TEE data. Finally, the procedure's predicted result of MR reduction was compared to the actual result for all patients.
Results:
238 consecutive patients were screened and analyzed between 2019 and 2022. 210 patients (88.2 %) met or increased the proctors' expectations regarding the perioperative result. On the other hand, 21 patients (8.8 %) did not meet the prediction. While a proctor supported every procedure, no prediction report was available in 4 cases (1.7%). However, a proctor supported every procedure. Three patients (1.3%) have been converted to classical open-heart surgery.
Conclusions:
A TEE-based prediction model is a helpful tool in clinical decision-making and in identifying patients who may benefit from a ringless MVR using the NeoChord procedure. TEE analysis and proctor evaluation are powerful tools for selecting patients benefiting from the NeoChord procedure.

Mitral Repair Techniques & Strategies