Edge-to-edge mitral valve repair with transapical neochord implantation Andrea Colli, MD, PhD, Laura Besola, MD, Eleonora Bizzotto, MD, Paolo Peruzzo,

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Presentation transcript:

Edge-to-edge mitral valve repair with transapical neochord implantation Andrea Colli, MD, PhD, Laura Besola, MD, Eleonora Bizzotto, MD, Paolo Peruzzo, PhD, Demetrio Pittarello, MD, Gino Gerosa, MD The Journal of Thoracic and Cardiovascular Surgery Volume 156, Issue 1, Pages 144-148 (July 2018) DOI: 10.1016/j.jtcvs.2018.02.008 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, All the neochords implanted were passed through a ligating loop (Surgitie 0; Medtronic, Minneapolis, Minn). B, The knot pusher of the ligating loop was advanced under echocardiographic guidance. C, The knot pusher and tensioning tourniquet were removed. D, Edge-to-edge neochord fixation was verified after the procedure. E, Direct visualization of the mitral valve was recorded with a fiberscope inserted in the left atrium to show implantation of the neochords. F, Direct visualization of the edge-to-edge repair was created by tensioning all the neochords together over a tourniquet. G, Direct visualization of the final aspect of the edge-to-edge repair. H, Two-dimensional epicardial echocardiography showing the flail of the posterior leaflet. I, Two-dimensional epicardial echocardiography showing the implanted neochords fixed over the tourniquet. J, Two-dimensional epicardial echocardiography showing the classic edge-to-edge leaflet fixation. K, Three-dimensional echocardiography showing the double-orifice image of the mitral valve. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 144-148DOI: (10.1016/j.jtcvs.2018.02.008) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Two-dimensional color Doppler transesophageal echocardiography showing severe mitral regurgitation. B, Three-dimensional echocardiography demonstrating the presence of partial severe calcification of the annulus and complex leaflet anatomy. C, Postoperative 2-dimensional color Doppler echocardiography confirming the presence of mild mitral regurgitation. D, Three-dimensional color Doppler echocardiography showing the presence of a mild mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 144-148DOI: (10.1016/j.jtcvs.2018.02.008) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, All implanted neochords were passed through a pediatric tourniquet and tensioned. B, The ligating loop system was advanced over the tourniquet. C, All neochords and the ligating loop were fixed, and the pediatric tourniquet was removed. D, The neochords and the ligating loop were passed through a single pledget and fixed on epicardial surface as usual for neochord repair. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 144-148DOI: (10.1016/j.jtcvs.2018.02.008) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Postoperative 2-chamber view transthoracic 2-dimensional echocardiography showing the implanted neochords in the left ventricle. B, Postoperative 2-chamber view color Doppler transthoracic 2-dimensional echocardiography showing the residual mitral regurgitation. C, Postoperative 4-chamber view transthoracic 2-dimensional echocardiography showing an appropriate plane of coaptation. D, Postoperative 4-chamber view color Doppler transthoracic 2-dimensional echocardiography showing the residual mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 144-148DOI: (10.1016/j.jtcvs.2018.02.008) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Intraoperative images showing the procedure's fundamental steps. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 144-148DOI: (10.1016/j.jtcvs.2018.02.008) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Ex vivo pulsatile heart model procedure simulation. Video available at: http://www.jtcvsonline.org/article/S0022-5223(18)30356-8/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 144-148DOI: (10.1016/j.jtcvs.2018.02.008) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 2 Transapical edge-to-edge mitral valve repair with neochord implantation surgical procedure and echocardiographic evaluation. 2D, Two-dimensional; 3D, three-dimensional; TEE, transesophageal echocardiography. Video available at: http://www.jtcvsonline.org/article/S0022-5223(18)30356-8/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 144-148DOI: (10.1016/j.jtcvs.2018.02.008) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions