Gerosa Gino, Nadali Matteo, Longinotti Lorenzo, Ponzoni Matteo, Caraffa Raphael, Fiocco Alessandro, Pradegan Nicola, Besola Laura, D'Onofrio Augusto, Bizzotto Eleonora, Bellu Roberto, Gentian Denas, Colli Andrea
Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Cardiology Unit, Policlinico di Abano, Abano Terme, Italy.
Ann Cardiothorac Surg. 2021 Jan;10(1):131-140. doi: 10.21037/acs-2020-mv-86.
The NeoChord echo-guided transapical beating heart repair is a promising early-stage minimally invasive surgical procedure for degenerative mitral valve (MV) regurgitation (DMR) correction. The technique has been improved since its inception following procedure standardization, patient selection optimization, and learning curve stabilization. We hereby present the mid-term clinical results through three years of our large single center experience.
All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both mitral leaflets that underwent the NeoChord procedure between November 2013 and June 2019 were included. Patients were categorized according to MV anatomy; Type A isolated central posterior leaflet prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular calcifications. Patients underwent clinical and echocardiographic follow-up at one, three, six, twelve months and yearly thereafter. Clinical outcomes and the composite primary endpoint (patient success) were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria. Mitral regurgitation (MR) severity was graded as absent, mild, moderate and severe according to American Society of Echocardiography (ASE) and European Society of Cardiology (ESC) guidelines.
Two hundred and three patients were included; median follow-up was 24 months [interquartile range (IQR), 9-36]. Median age was 64 years (IQR, 54-74 years), median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) was 0.60% (IQR, 0.32-1.44%). There were 106 Type A patients (52.2%), 68 Type B (33.5%), 16 Type C (7.9%), and 13 Type D (6.4%). Kaplan-Meier estimate of survival was 99.0%±0.7% at one and two years and 94.0%±2.9% at three years. At one-year follow-up patient success was 91.2%±2.0% and 111 patients (74%) presented a residual MR mild or less (1+). At three-year follow-up patient success was 81.2%±3.8% and 32 patients (64%) had a residual MR mild or less (1+). Patient success was significantly different according to anatomical type (P=0.001). Echocardiographic analysis showed a significant acute left ventricle and left atrial reverse remodeling that was maintained up to three years.
The NeoChord echo-guided transapical beating heart repair procedure demonstrated good clinical outcomes and echocardiographic results up to three-year follow-up.
NeoChord 超声引导经心尖跳动心脏修复术是一种有前景的早期微创手术，用于纠正退行性二尖瓣反流（DMR）。自该技术问世以来，经过手术标准化、患者选择优化和学习曲线稳定化，其已得到改进。在此，我们通过单中心三年的大量经验展示中期临床结果。
纳入 2013 年 11 月至 2019 年 6 月期间因一个或两个二尖瓣叶脱垂或连枷样病变而接受 NeoChord 手术的所有连续性严重症状性 DMR 患者。根据二尖瓣解剖结构对患者进行分类：A型为孤立的中央后叶脱垂和/或连枷样病变，B 型为后叶多节段脱垂和/或连枷样病变，C 型为前叶和/或双叶脱垂或连枷样病变，D 型为瓣周脱垂和/或连枷样病变及/或显著的瓣叶和/或瓣环钙化。患者在术后 1、3、6、12 个月及之后每年接受临床和超声心动图随访。临床结局和复合主要终点（患者成功）根据二尖瓣学术研究联盟（MVARC）标准定义。根据美国超声心动图学会（ASE）和欧洲心脏病学会（ESC）指南，二尖瓣反流（MR）严重程度分为无、轻度、中度和重度。
纳入 203 例患者；中位随访时间为 24 个月[四分位间距（IQR），9 - 36]。中位年龄为 64 岁（IQR，54 - 74 岁），中位胸外科医师协会（STS）预测死亡率（PROM）为 0.60%（IQR，0.32 - 1.44%）。有 106 例 A 型患者（52.2%），68 例 B 型患者（33.5%），16 例 C 型患者（7.9%）和 13 例 D 型患者（6.4%）。1 年和 2 年时 Kaplan - Meier 生存估计值分别为 99.0%±0.7%和 94.0%±2.9%，3 年时为 94.0%±2.9%。1 年随访时患者成功率为 91.2%±2.0%，111 例患者（74%）存在轻度或更低程度（1 + ）的残余 MR。3 年随访时患者成功率为 81.2%±3.8%，32 例患者（64%）存在轻度或更低程度（1 + ）的残余 MR。患者成功率根据解剖类型有显著差异（P = 0.001）。超声心动图分析显示左心室和左心房有显著的急性逆向重构，且这种重构持续至 3 年。
NeoChord 超声引导经心尖跳动心脏修复术在长达三年的随访中显示出良好的临床结局和超声心动图结果。
