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. 2012 Jan;41(1):173-6; discussion 176.
doi: 10.1016/j.ejcts.2011.03.058.

Trans-apical beating-heart implantation of neo-chordae to mitral valve leaflets: results of an acute animal study

Joerg Seeburger  1 , Sergej Leontjev, Michael Neumuth, Thilo Noack, Michael Höbartner, Martin Misfeld, Michael A Borger, Friedrich W Mohr
Affiliations

Trans-apical beating-heart implantation of neo-chordae to mitral valve leaflets: results of an acute animal study

Joerg Seeburger et al. Eur J Cardiothorac Surg. 2012 Jan.

Abstract

Objective: Trans-apical beating-heart implantation of neo-chordae is yet an experimental procedure for mitral valve (MV) repair. We aimed to assess the performance of a new device in an acute animal study.

Methods: A total of four domestic adolescent pigs were used as an acute model. The MV was assessed on the beating heart through a conventional trans-apical access. The NeoChord DS1000 device was used to implant polytetrafluoroethylene (PTFE) sutures to the MV leaflets. Procedural performance of the device was assessed and completed with surgical workflow analysis.

Results: Overall 57 implantations using epicardial echocardiography guidance were performed (mean 14.3 implantations per animal). The MV leaflets were successfully grasped every second attempt (mean 2.3±1.9) with no difference between the anterior and the posterior leaflet. A significant difference between an 'expert' surgeon (n>20 implantations) and beginner surgeon was detected with regard to the duration for successful leaflet grasping (65±73 vs 127±105 s; p=0.02) and the overall duration for implantation (130±86 vs 230±119 s; p=0.002). Gross anatomy did not show major tear of leaflets. There were no device-related technical problems.

Conclusion: The NeoChord DS1000 device for trans-apical beating-heart implantation of neo-chordae to the MV valve showed a high procedural success. A significant difference between an expert and beginner surgeon was detected, which emphasizes the importance of training before introduction of this new technique into clinical practice. Surgical workflow analysis proved to be a valuable tool to assess the performance of this new technique.

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Figures

Figure 1:
Figure 1:
The NeoChord DS1000 device for application of neochordae to the mitral valve. The device is shown including the device monitor, which is used to confirm sufficient grasp.
Figure 2:
Figure 2:
The NeoChord DS1000 delivery system within the left atrium in an echocardiographic long axis view of an acute animal model. The device has been introduced through the apex of the heart and the jaws of the device are open toward the anterior mitral leaflet. When aiming for the posterior leaflet the device needs to be twisted for 180°. AML = anterior mitral leaflet; PML = posterior mitral leaflet; LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract.
Figure 3:
Figure 3:
After deploying the neo-chordae to the posterior leaflet the device is retracted through the apical access. The neo-chordae is then suspended between the PML and apex of the heart at the desired length. AML = anterior mitral leaflet; PML = posterior mitral leaflet; LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract.
See this image and copyright information in PMC

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