MP47. Preoperative TEE Analysis and its Predictive Value in Patients Undergoing Beating Heart Mitral Valve Repair
Klinikum Nürnberg, Nuremberg, Germany
Nuremberg, Bavaria
Germany - Contact Me
I work as Chief Senior Physician in the Department of Cardiac Surgery at Artemed Clinic Munich South in Munich, Germany and as a teacher and researcher at the Paracelsus Medical University in Nuremberg, Germany. My interests ar minimal-invasive heart valve procedures. On that topic I am also involved in the development of a transcatheter system for AR at the University of Cape Town.
My habilitation (PD) at the Paracelsus Medical University focused on avoiding complications in minimal invasive aortic valve therapies. In 2015, I finished my Master of Health Business Administration (MHBA) at the Friedrich-Alexander University in Nuremberg, Erlangen, Germany. I graduated from the University of Vienna with a degree in medicine and also have a MD degree from the Ludwig-Maximilians-University of Munich.
I am married and have two children.
Description
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.