An early European experience with transapical off-pump mitral valve repair with NeoChord implantation

被引:109
作者
Colli, Andrea [1 ]
Manzan, Erica [1 ]
Aidietis, Audrius [2 ]
Rucinskas, Kestutis [2 ]
Bizzotto, Eleonora [1 ]
Besola, Laura [1 ]
Pradegan, Nicola [1 ]
Pittarello, Demetrio [1 ]
Janusauskas, Vilius [2 ]
Zakarkaite, Diana [2 ]
Drasutiene, Agne [2 ]
Lipnevicius, Arturas [2 ]
Danner, Bernhard C. [3 ]
Sievert, Horst [4 ]
Vaskelyte, Laura [4 ]
Schnelle, Nalan [4 ]
Salizzoni, Stefano [5 ]
Marro, Massimo [5 ]
Rinaldi, Mauro [5 ]
Kurnicka, Katarzyna [6 ]
Wrobel, Kristof [7 ]
Ceffarelli, Mariano [8 ]
Savini, Carlo [8 ]
Pacini, Davide [8 ]
Gerosa, Gino [1 ]
机构
[1] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Cardiac Surg Unit, Padua, Italy
[2] Vilnius Univ, Dept Cardiovasc Med, Vilnius, Lithuania
[3] Georg August Univ, Univ Med Ctr, Dept Thorac & Cardiovasc Surg, Gottingen, Germany
[4] Sankt Katharinen, CardioVasc Ctr Frankfurt CVC, Frankfurt, Germany
[5] Univ Turin, Citta Salute & Sci Torino, Dept Surg Sci, Div Cardiac Surg, Turin, Italy
[6] Med Univ Warsaw, Dept Internal Med & Cardiol, Warsaw, Poland
[7] Medicover Hosp, Dept Cardiac Surg, Warsaw, Poland
[8] Bologna Univ, SantOrsola Malpighi Hosp, Dept Cardiovasc Surg, Bologna, Italy
关键词
Mitral valve repair; NeoChord; Transapical; Echo guided; Off-pump; Registry; REGURGITATION; REPLACEMENT; PROLAPSE; CHORDAE;
D O I
10.1093/ejcts/ezy064
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: Transapical off-pump NeoChord repair is a novel minimally invasive surgical procedure to treat degenerative mitral valve regurgitation. The aim was to evaluate 1-year clinical results of the NeoChord procedure in a consecutive cohort of patients. METHODS: Between February 2013 and July 2016, 213 patients were enrolled in the NeoChord Independent International Registry. All patients presented severe mitral regurgitation due to flail/prolapse of 1 or both leaflets, and they all completed postoperative echocardiographic assessment up to 1 year. We identified the primary end point as composed of procedural success, freedom from mortality, stroke, reintervention, recurrence of severe mitral regurgitation, rehospitalization and decrease of at least 1 New York Heart Association functional class at 1-year follow-up. We also compared outcomes according to the anatomical classification (Type A: isolated central posterior leaflet disease; Type B: posterior multisegment disease; Type C: anterior, bileaflet, paracommissural disease with/without leaflet/annular calcifications). RESULTS: The median age was 68 years (interquartile range 56-77), and the median EuroSCORE II was 1.05% (interquartile range 0.67-1.76). The number of Type A, B and C patients was 82 (38.5%), 98 (46%) and 33 (15.5%), respectively. Procedural success was achieved in 206 (96.7%) patients. At 1-year follow-up, overall survival was 98 +/- 1%. Composite end point was achieved in 84 +/- 2.5% for the overall population and 94 +/- 2.6%, 82.6 +/- 3.8% and 63.6 +/- 8.4% in Type A, Type B and Type C patients, respectively (P < 0.0001). CONCLUSIONS: These results demonstrate that the NeoChord procedure is safe, effective and reproducible. Clinical and echocardiographic efficacy is maintained up to 1 year with significant differences among the anatomical groups. Specific anatomical selection criteria are necessary to achieve stable results.
引用
收藏
页码:460 / 466
页数:7
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