Thirteen patients with severe mitral regurgitation and isolated posterior mitral valve leaflet prolapsed underwent operation with the NeoChord DS1000 system. Mitral valve dimensions were anteroposterior 34 mm (29-45 mm) and mediolateral 40 mm (29-58 mm). All patients had an ejection fraction greater than 55%. With a beating heart, through a left anterolateral thoracotomy, under transesophageal echocardiographic guidance, the聽NeoChord DS1000 was introduced into the left ventricle 2 to 4 cm posterolateral from the apex. The prolapsed leaflet was grasped with the device, and expanded polytetrafluoroethylene suture deployed and attached to the posterior leaflet. Six patients received 2 sutures, 4 received 3 sutures, and 2 received 4 sutures. All patients reached 6 months' follow-up and underwent transthoracic echocardiography to evaluate mitral regurgitation.
Median operative duration was 113 minutes (80-150 minutes). Less than second-degree mitral regurgitation in 6 months was achieved in 11 patients (85%). One patient (8%) had recurrent mitral regurgitation in 1 month, and another had conversion to conventional mitral valve repair because of leaflet damage with the device. There were no further serious procedure-related complications.
Beating-heart transapical neochord implantation was feasible, could be performed safely, and resulted in a relatively short procedure time. Larger studies and longer follow-up are needed to validate these promising results.