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Das C, Al Awwa G, Mills EL, Lantz G. Minimally Invasive Mitral Valve Repair Using Transcatheter Chordal Attachments. Interv Cardiol Clin 2024; 13:257-269. [PMID: 38432768 DOI: 10.1016/j.iccl.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
The advent of transcatheter mitral chordal replacement techniques has offered an alternative approach that is less invasive and may be more suitable for select patients compared with surgical repair. These systems involve introducing artificial chordae, via catheter, to replace or supplement damaged or elongated natural chordae. These artificial chordae are anchored at one end to the mitral leaflet and the other end to the papillary muscle or directly to the left ventricular apex, restoring the leaflet's coaptation and reducing regurgitation. Early trials and studies suggest promising results in terms of safety and efficacy in reducing MR severity and improving symptoms.
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Affiliation(s)
- Chandan Das
- Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L353, Portland, OR 97239, USA
| | - Ghayth Al Awwa
- Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L353, Portland, OR 97239, USA
| | - Emmanuel L Mills
- Knight Cardiovascular Institute, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code UHN-62, Portland, OR 97239, USA
| | - Gurion Lantz
- Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L353, Portland, OR 97239, USA.
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Bergonzoni E, D’Onofrio A, Mastro F, Gerosa G. Microinvasive mitral valve repair with transapical mitral neochordae implantation. Front Cardiovasc Med 2023; 10:1166892. [PMID: 37576109 PMCID: PMC10416619 DOI: 10.3389/fcvm.2023.1166892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Microinvasive cardiac surgery includes procedures performed off-pump, on the beating heart, with limited or absent skin incision, and those that rely on live imaging techniques. Transapical off-pump beating heart neochordae implantation allows the repair of severe mitral valve regurgitation due to leaflet prolapse or flail with live three-dimensional echo guidance. This procedure has shown good results for up to 5 years and can be considered as a valid alternative to conventional surgery in selected patients with high prediction of success based on clinical and anatomical considerations. The aim of this review is to describe the devices, indications, patient screening process, clinical and echocardiographic results, and future perspectives of this procedure.
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Tomšič A, Klautz RJM, Borger MA, Palmen M. Microinvasive mitral valve surgery: Current status and status quo. Front Cardiovasc Med 2023; 10:1094969. [PMID: 37180783 PMCID: PMC10169618 DOI: 10.3389/fcvm.2023.1094969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Surgical mitral valve repair, performed either through median sternotomy or minimal invasive approach, presents the gold standard treatment for degenerative mitral valve disease. In dedicated centres, high repair and low complication rates have been established with excellent valve repair durability. Recently, new techniques have been introduced, that allow mitral valve repair to be performed through small surgical incisions and while avoiding cardio-pulmonary bypass. These new techniques, however, conceptually differ significantly when compared to surgical repair and it remains questionable whether they are capable of reproducing the results of surgical treatment.
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Affiliation(s)
- Anton Tomšič
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Michael A. Borger
- Leipzig Heart Center, University Clinic for Cardiac Surgery, Leipzig, Germany
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Seifu S, de Marchena E. Microinvasive mitral valve surgery: A new frontier to tackle mitral regurgitation. J Card Surg 2022; 37:4062-4063. [PMID: 34608674 DOI: 10.1111/jocs.16013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Solomon Seifu
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eduardo de Marchena
- Division of cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Cocchieri R, van de Wetering B, van Tuijl S, Mousavi I, Riezebos R, de Mol B. At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology. J Cardiovasc Dev Dis 2022; 9:jcdd9080261. [PMID: 36005425 PMCID: PMC9410306 DOI: 10.3390/jcdd9080261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/15/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Almost 30 years after the first endoscopic mitral valve repair, Minimally Invasive Mitral Valve Surgery (MIMVS) has become the standard at many institutions due to optimal clinical results and fast recovery. The question that arises is can already good results be further improved by an Institutional Risk Management Performance (IRMP) system in decreasing risks in minimally invasive mitral valve surgery (MIMVS)? As of yet, there are no reports on IRMP and learning systems in the literature. (2) Methods: We described and appraised our five-year single institutional experience with MIMVS in isolated valve surgery included in the Netherlands Heart Registry (NHR) and investigated root causes of high-impact complications. (3) Results: The 120-day and 12-month mortality were 1.1% and 1.9%, respectively, compared to the average of 4.3% and 5.3% reported in the NHR. The regurgitation rate was 1.4% compared to 5.2% nationwide. The few high-impact complications appeared not to be preventable. (4) Discussion: In MIMVS, freedom from major and minor complications is a strong indicator of an effective IRMP but remains concealed from physicians and patients, despite its relevance to shared decision making. Innovation adds to the complexity of MIMVS and challenges surgical competence. An IRMP system may detect and control new risks earlier. (5) Conclusion: An IRMP system contributes to an effective reduction of risks, pain and discomfort; provides relevant input for shared decision making; and warrants the safe introduction of new technology. Crossroads conclusions: investment in machine learning and AI for an effective IRMP system is recommended and the roles for commanding and operating surgeons should be considered.
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Affiliation(s)
- Riccardo Cocchieri
- Cardiothoracic Surgeon, OLVG Hospital, 1091 AC Amsterdam, The Netherlands
| | - Bertus van de Wetering
- Biomedical Engineer, LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
| | - Sjoerd van Tuijl
- Biomedical Engineer, LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
| | - Iman Mousavi
- Cardiothoracic Surgery Resident, OLVG Hospital, 1091 AC Amsterdam, The Netherlands
| | - Robert Riezebos
- Cardiologist, OLVG Hospital, 1091 AC Amsterdam, The Netherlands
| | - Bastian de Mol
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
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Gerosa G, Thourani VH, Borger M, D'Onofrio A. Microinvasive cardiac surgery: when less is more-'render to Caesar the things that are Caesar's; and to the surgeon the things that are the surgeons''. Eur J Cardiothorac Surg 2022; 62:6528408. [PMID: 35157037 DOI: 10.1093/ejcts/ezac084] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/06/2022] [Accepted: 02/11/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Michael Borger
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
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Song C, Fan Y, Jiang S. Discussion regarding the anchoring position of chordae in transapical MVP. J Card Surg 2021; 37:465. [PMID: 34845756 DOI: 10.1111/jocs.16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chao Song
- Medical School of Chinese PLA, Beijing, China.,Department of Cardiovascular Surgery, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yunlong Fan
- Medical School of Chinese PLA, Beijing, China.,Department of Cardiovascular Surgery, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
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