Off-pump transapical implantation of artificial chordae to correct mitral regurgitation: Early results of a single-center experience

ObjectivesThis study evaluated the safety and efficiency of the NeoChord DS1000 system (NeoChord, Inc, Minneapolis, Minn), a device designed to deliver artificial chordae tendineae (neochords) in a beating heart with minimally invasive techniques through left anterolateral minithoracotomy.MethodsThirteen patients with severe mitral regurgitation and isolated posterior mitral valve leaflet prolapsed underwent operation with the NeoChord DS1000 system. Mitral valve dimensions were anteroposterior 34 mm (29-45 mm) and mediolateral 40 mm (29-58 mm). All patients had an ejection fraction greater than 55%. With a beating heart, through a left anterolateral thoracotomy, under transesophageal echocardiographic guidance, the NeoChord DS1000 was introduced into the left ventricle 2 to 4 cm posterolateral from the apex. The prolapsed leaflet was grasped with the device, and expanded polytetrafluoroethylene suture deployed and attached to the posterior leaflet. Six patients received 2 sutures, 4 received 3 sutures, and 2 received 4 sutures. All patients reached 6 months' follow-up and underwent transthoracic echocardiography to evaluate mitral regurgitation.ResultsMedian operative duration was 113 minutes (80-150 minutes). Less than second-degree mitral regurgitation in 6 months was achieved in 11 patients (85%). One patient (8%) had recurrent mitral regurgitation in 1 month, and another had conversion to conventional mitral valve repair because of leaflet damage with the device. There were no further serious procedure-related complications.ConclusionsBeating-heart transapical neochord implantation was feasible, could be performed safely, and resulted in a relatively short procedure time. Larger studies and longer follow-up are needed to validate these promising results.