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Eur J Cardiothorac Surg. 2018 Sep 1;54(3):460-466. doi: 10.1093/ejcts/ezy064.

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

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Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania.
Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany.
CardioVascular Center Frankfurt CVC, Sankt Katharinen, Frankfurt, Germany.
Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland.
Department of Cardiovascular Surgery, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.



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.


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).


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).


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.


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