2020 Volume 84 Issue 11 Pages 2033-
All procedures were in accordance with the “Declaration of Helsinki” and the ethical standards of the responsible committee on human experimentation.
Transapical off-pump mitral valve repair (MVR) with the Neochord device, which can be performed without cardiopulmonary bypass, was developed as an alternative to conventional surgeries for the treatment of mitral regurgitation (MR).1
The indication of this procedure was sole posterior valve leaflet prolapse (P2 is preferable) with preserved ejection fraction. Two patients (77- and 69-year-old men) with severe MR due to P2 prolapse (Figure A) underwent NeoChord MVR. A 4-cm incision was made in the 5th intercostal space, and apical access was secured with 2 purse-string sutures and felt pledgets. After systemic heparinization, the NeoChord system (DS1000 Artificial Chordae Delivery System; NeoChord Inc., St. Louis Park, MN, USA) was inserted, and the tip of the instrument was manipulated through the mitral valve under echocardiographic guidance (Figure B). The P2 leaflet was carefully grasped, 3 or 4 new artificial chordae were punched through the leaflet, and the artificial chordae were pulled out from the apex. The free ends of all artificial chordae were passed through a single felt pledget. After neutralization of heparinization, the artificial chordae lengths were adjusted using echocardiography and anchored and tied down at the left ventricular apex. (Figure C) The patients were extubated in the operating room. The operative time was 109 and 172 min, respectively, and blood transfusion was not required. Postoperatively, there was trivial MR (Figure D).
(A) Preoperative transesophageal echocardiography (TEE). (B) The NeoChord device is inserted from the apex of the left ventricle. (C) New artificial chordae are fixed at the ventricle apex. (D) Postoperative TEE in the same patient.
Though there are a few restrictions in patient selection and requirement for longer follow-up, off-pump NeoChord implantation could be a promising treatment of MR in Japan.
Y. Sawa, Y. Sakata are members of Circulation Journal’s Editorial Team. The DS1000 Artificial Chordae Delivery System was supplied by General Medical Ltd.
