Brown Amy, Jefferson Hallie L, Fatehi Hassanabad Ali, Noss Christopher, Webb Nicole, Fedak Paul W M, Kent William D T, Adams Corey
Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.
Department of Anesthesiology, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.
Front Cardiovasc Med. 2023 Jun 23;10:1160979. doi: 10.3389/fcvm.2023.1160979. eCollection 2023.
The NeoChord DS1000 system implants artificial neochords transapically, through a left mini-thoracotomy to treat degenerative mitral valve regurgitation (MR). Performed without cardiopulmonary bypass, neochord implantation and length adjustment is guided by transesophageal echocardiography. We describe imaging and clinical outcomes for a single center case series using this innovative device platform.
In this prospective series, all study patients had degenerative MR and were considered for conventional mitral valve surgery. Moderate to high-risk candidates were screened for NeoChord DS1000 eligibility based on echocardiographic criteria. Study criteria included isolated posterior leaflet prolapse, leaflet-to-annulus index greater than 1.2, and coaptation length index greater than 5 mm. Patients with bileaflet prolapse, mitral annular calcification, and ischemic MR were excluded from our early experience.
Ten patients underwent the procedure, including 6 males and 4 females, with a mean age of 76 ± 9.5 years. All patients had severe chronic MR and normal left ventricular function. One patient required conversion to an open procedure for failure to deploy neochords with the device transapically. The median number of NeoChord sets was 3 (IQR 2.3-3.8). Immediate post-procedure (POD#0) degree of MR on echocardiography ranged from mild or less, and on postoperative day 1 (POD#1) from moderate or less. Average length of coaptation was 0.85 ± 0.21 cm and average depth of coaptation was 0.72 ± 0.15 cm. At 1-month follow-up echocardiography, MR was graded from trivial to moderate and left ventricular inner diameter dimensions decreased from an average of 5.4 ± 0.4 cm to 4.6 ± 0.3 cm. None of the patients who had successful NeoChord implantation required blood products. There was 1 perioperative stroke with no residual deficits. There were no device-related complications or serious adverse events. The median length of hospital stay was 3 (IQR 2.3-10) days. 30-day and 6-weeks postoperative mortality and readmission rates were 0%.
We report the first Canadian case series using the NeoChord DS1000 system for off-pump, transapical, beating heart mitral valve repair, through a left mini-thoracotomy. The early surgical outcomes suggest this approach is feasible, safe, and effective in reducing MR. This novel procedure has the advantage of offering a minimally invasive, off-pump option for select patients with high surgical risk.
NeoChord DS1000系统通过左胸小切口经心尖植入人工新腱索，用于治疗退行性二尖瓣反流（MR）。该手术无需体外循环，新腱索植入及长度调整在经食管超声心动图引导下进行。我们描述了使用这一创新设备平台的单中心病例系列的影像学及临床结果。
在这个前瞻性系列研究中，所有研究患者均患有退行性MR，且被考虑进行传统二尖瓣手术。根据超声心动图标准筛选中度至高度风险的患者是否符合NeoChord DS1000系统的使用条件。研究标准包括孤立的后叶脱垂、瓣叶与瓣环指数大于1.2以及对合长度指数大于5毫米。双叶脱垂、二尖瓣环钙化和缺血性MR患者被排除在我们的早期经验之外。
10例患者接受了该手术，其中男性6例，女性4例，平均年龄为76±9.5岁。所有患者均患有严重慢性MR且左心室功能正常。1例患者因经心尖使用该设备未能成功部署新腱索而需要转为开胸手术。NeoChord装置的中位数为3个（四分位间距2.3 - 3.8）。术后即刻（术后第0天）超声心动图显示的MR程度为轻度或更低，术后第1天为中度或更低。平均对合长度为0.85±0.21厘米，平均对合深度为0.72±0.15厘米。在1个月随访超声心动图检查时，MR分级为微量至中度，左心室内径尺寸从平均5.4±0.4厘米降至4.6±0.3厘米。成功植入NeoChord的患者均无需输血制品。围手术期发生1例卒中，无残留神经功能缺损。无与设备相关的并发症或严重不良事件。中位住院时间为3天（四分位间距2.3 - 10天）。术后30天和6周的死亡率及再入院率均为0%。
我们报告了加拿大首例使用NeoChord DS1000系统通过左胸小切口进行非体外循环、经心尖、心脏跳动中二尖瓣修复的病例系列。早期手术结果表明该方法在降低MR方面是可行、安全且有效的。这种新手术具有为部分高手术风险患者提供微创、非体外循环选择的优势。
