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Int J Cardiol. 2018 Apr 15;257:230-234. doi: 10.1016/j.ijcard.2018.01.026. Epub 2018 Jan 31.

Acute intraoperative echocardiographic changes after transapical off-pump mitral valve repair with NeoChord implantation.

Author information

1
Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy. Electronic address: colli.andrea.bcn@gmail.com.
2
Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
3
Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy; Cardiology Unit, Policlinico di Abano Terme, Italy.
4
Institute of Anesthesia, Department of Medicine, University of Padua, Italy.

Abstract

OBJECTIVES:

Our aim is to investigate the acute intraoperative effects of the NeoChord repair procedure on mitral valve (MV) annular geometry and LV function and the impact of these changes on MR at 1-year follow-up.

BACKGROUND:

Recently transapical off-pump mitral valve repair with NeoChord implantation has been demonstrated to be safe and effective in patients with degenerative mitral regurgitation (DMR).

METHODS:

We retrospectively analyzed baseline and early postoperative 3-dimensional transesophageal echocardiography of 66 patients who underwent NeoChord repair for isolated posterior leaflet MV disease using semiautomatic off-line analysis software.

RESULTS:

We observed a significant acute reduction of indexed LV end diastolic volume (Δ% = 14, p < .001), LV ejection fraction (Δ = 5.7%, p = .002), indexed left atrial volume (Δ = 14.7%, p = .045), and pulmonary artery pressure (Δ = 2.1%, p = .026). Among MV geometric parameters, we observed a significant reduction of MV antero-posterior diameter (Δ = 7%, p < .001), sphericity index (Δ = 8%, p < .001), annulus circumference (Δ = 0.9%, p = .021), and annulus area (Δ = 2.7%, p = .018). At 1-year, 53 patients (85.5%) presented MR ≤ mild, while 9 patients (14.5%) had MR ≥ moderate. Reduction of AP diameter (OR = 0.14, CI -3.83; 0.08, p < .001), annulus circumference (OR = 0.27, CI -2.98; 0.37, p = .005), MV area (OR = 0.39, CI -2.46; 0.61, p = .04), aorto-mitral angle (OR = 0.38, CI -2.49; 0.54, p = .002) and iEDV (OR = 0.44, CI -2.44; 0.81, p = .001) were independent protective factors against recurrence of MR greater than mild at 1-year follow-up.

CONCLUSIONS:

Transapical NeoChord repair produces important acute intraoperative changes in MV anatomy in DMR patients. The acute changes observed were associated with procedure durability at 1-year FU.

KEYWORDS:

3D echocardiography; Mitral annular geometry; Mitral valve flail; Mitral valve prolapse; Mitral valve regurgitation; NeoChord

PMID:
29395366
DOI:
10.1016/j.ijcard.2018.01.026
[Indexed for MEDLINE]

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