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Clinical Impact Of Residual Moderate Mitral Regurgitation After Neochord Implantation

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1- OBJECTIVES: traditionally mitral valve (MV) repair is considered successful when post-procedural mitral regurgitation (MR) is less than mild. Moderate residual MR is considered acceptable only in high risk patients or after percutaneous MV correction. Transapical off-pump Neochord implantation (TOP-MINI) is a safe and effective minimally-invasive procedure to correct degenerative MR due to leaflet prolapse/flail. Aim of our study is to evaluate clinical impact of residual moderate MR after TOP-MINI procedure at mid-term follow-up (FU).

2- METHODS: Among 49 patients treated with Neochord procedure between November 2013 and December 2014, we selected 13 patients (26.5%) who presented residual moderate MR (group A) and 36 patients (73.5%) who presented mild or no residual MR at discharge (group B). For each patient we analyzed the clinical status (NYHA functional class) at 6-months FU. Retrospectively we investigated which preoperative clinical and echocardiographic parameters and MV anatomical features can represent a risk factor for residual moderate MR.

3- RESULTS: Preoperatively all 49 patients presented symptomatic severe MR (NYHA class III or IV). Preoperative features are presneted in Table 1. At discharge 13 patients (26,5%) presented residual moderate MR and they were all in NYHA class I. At 6-month FU all patients maintained a moderate residual MR. Seven patients (53,8%) were in NYHA class I, 6 (46,2%) in NYHA class II. No one needed re-hospitalization for cardiac causes and we did not observe any death or need of reintervention during FU period. Group A differed significantly from Group B for clinical features, while they presented similar pre-operative echocardiographic parameters. Patients in Group A were older and with a higher surgical risk. LVEF was similar, but most patients had a moderate tricuspid regurgitation, moderate/severe pulmonary hypertension and LVEDV >90 ml/m2. The mostrelevantdifferencebetween the 2 groupswas MV anatomy, assessed by pre-operative 3D transesophageal echocardiography. Group A presented a more complex MV anatomy to be treated. Anatomycal differences are shown in Table 3.

-The presence of a Residual Moderate MR after TOP-MINI provides GOOD CLINICAL outcomes at 6 months follow-up


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