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Transapical endovascular implantation of neochordae using a suction and suture device

^a San Raffaele Cardio-Thoracic and Vascular Department, Milano, Italy
^b Veterinarian Medicine School, University of Milan, Italy
^c Edwards Lifesciences LLC, Irvine CA, USA

Received 2 September 2008; received in revised form 31 December 2008; accepted 6 January 2009.

^_* Corresponding author. Address: Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy. Tel.: +39 02 26437111; fax: +39 02 26417125. (Email: francesco.maisano{at}hsr.it).

Objective: Neochordae implantation is a standard method for treatment of mitral valve prolapse. We describe a transcatheter technology enabling transapical endovascular chordal implantation. Methods: Six adult pigs were anesthetized. Two 10F sheaths were introduced in the femoral vessels for monitoring and intracardiac echo. After midline sternotomy, the pericardium was opened, the apex was punctured inside two 2–0 polypropylene purse strings. A 0.035 in J tipped guidewire was introduced in the left ventricle and an ultra stiff 14F sheath (guide catheter) inserted through the apex. A suction-and-suture device was introduced in the left ventricle. The mitral valve was crossed under echo guidance. Using suction, either the anterior (two cases) or posterior (four cases) leaflet was captured and a loop of 4–0 polypropylene was thrown at the edge of the leaflet. The loop, with a pledget, was exteriorized through the introducer. The introducer was removed and the purse-string tied. Under echo guidance, the neochordae suture was pulled and tied over a pledget to evoke leaflet tethering. The animals were sacrificed and gross anatomy reviewed. Results: Leaflet capture was feasible in the intended location in all cases. Following suture tethering, variable degrees of MR were obtained. At gross anatomy, the neochordae were positioned at 1–4 mm from the leaflet free edge, and were firmly attached to the leaflets. Conclusions: Transcatheter endovascular neochordae implantation is feasible. A prolapse model is needed to further demonstrate feasibility under pathologic conditions. The apical approach allows easy and direct route to transcatheter beating heart minimally invasive mitral repair.

Key Words: Mitral valve regurgitation • Transcatheter valve repair • Valve repair • Beating heart • Minimally invasive surgery • Transapical approach

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				F. W. Mohr Editorial comment Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 123 - 123. [Full Text] [PDF]