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Off Pump Mitral Valve Repair With Neochord From Pioneering To Clinical Practise. Early Experience From Two Associate Centers: What We Are Learning
ALBERTO ALBERTINI1, Luigi Martinelli2, Luca Caprili1, Leopoldo Bardano2.
1SALUS HOSPITAL GVM Care & Research, REGGIO EMILIA, Italy, 2ICLAS GVM Care & Research, Rapallo, Italy.

Objective
Transapical off-pump mitral valve repair with Neochord implantation is a promising new technique aimed to further reduce the invasiveness of mitral surgery by avoiding cardiopulmonary bypass, cardiac arrest and open heart surgery. Up to now, according to Neochord Company data, in Europe there are only three centers that exceed 50 cases. We report our experience of mitral valve repairs using Neochord Tecnology that started in November 2015 in two associate centers of GVM care & research Hospital Group: Salus Hospital in Reggio Emilia and ICLAS in Rapallo.
Methods
From November 2015 to October 2016 we operated on 31 consecutive patients with severe mitral regurgitation using off-pump mitral valve repair with Neochord implantation. Patient (26 males, mean age 65,6 years, range 40-87) had a mean Logistic EuroSCORE of 5 (range 2-15), 19 were operated at ICLAS GVM care & research in Rapallo and 12 at Salus Hospital GVM care & research in Reggio Emilia. A total number of 110 Neochord were implanted with a mean value of 4 Neochord per procedure (range 2-5).
Results
1 patient died not for cardiac related causes in second postoperative day, one patient was converted to conventional on pump right minithoracotomy mitral valve repair due to the rupture of two chordae tendinae of the anterior leaflet during the retrieving of the instrument after Neochord implantation. Mean intubation time was 6 hours (range 2-28), mean hospital stay was 6 days (range 3-10), Mean follow up is 8 months (range 1-5) . Two patients required a second mitral valve procedure for recurrent mitral regurgitation, in one case for the ruputure of the ventricular insertion of the Neochord at three months and in one case for the thetering of the posterior leaflet due to the progression of the left ventricular dilatation at four months.
Conclusions
Mitral valve repair with Neochord implantation is leaving the pioneeristic phase, indications and results are being defined with the increasing number of procedure as many pitfalls and technical problems are emerging and consequently corrected by the increasing experience acquired by the surgeons.


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