(P185) EARLY OUTCOMES OF NEOCORD DS1000 TRANSAPICAL OFF-PUMP REPAIR OF SEVERE MITRAL REGURGITATION IN HIGH-RISK PATIENTS: A SINGLE CENTRE CASE SERIES STUDY

Background: Surgical mitral valve repair (MVr) with artificial neocordae is associated with excellent outcomes. The NeoChord DS1000 system is a device that implants neochords transapically, off-pump, through a left mini thoracotomy. This study describes the immediate post-operative and 30-day outcomes for a single center case series of four consecutive patients.

METHODS AND RESULTS: Twenty patients with degenerative mitral valve disease (Carpentier Type A) were screened for MVr with the NeoChord DS100 device. Based on echo criteria, 6 patients were accepted, and 4 underwent the procedure. Anatomical inclusion criteria consisted of degenerative mitral valve regurgitation (MR), isolated posterior leaflet prolapse, leaflet to annulus index greater than 1.2, and coaptation length index greater than 5 mm. Anatomical exclusion criteria included multi-leaflet pathology, mitral annular calcification, and ischemic MR. Four patients underwent intervention with the NeoChord DS1000 system. Two were male, and the median age was 74 (65-87). All patients had significant comorbidities, including frailty, dementia, severe pulmonary hypertension, peripheral vascular disease, and 2 were not candidates for conventional surgery. The NeoChord DS1000 was successfully implanted in all patients trans-apically. The average number of NeoChord sets was 2.5 (2-3). Immediate post-procedure degree of MR on echocardiography ranged from trace to mild MR. No patient died perioperatively, and there were no strokes. None of the patients required blood products. Mean duration of intubation was 4.16 hr (2.5-5.75 hours). Mean length of ICU stay was 21.4 hr (20.5-22.3 hours), and the thirty-day mortality was 0%. The degree of residual MR on post-operative day 1 ranged from none to mild. Average length of coaptation was 1.1cm (0.54-1.6cm), and average depth of coaptation was 0.59 cm (0.52-0.65cm).

Conclusion: This case series represents the first reported Canadian experience with the NeoChord DS1000 system for off-pump, transapical, beating heart mitral valve repair, through a left mini-thoracotomy. The early surgical outcomes suggest this approach is safe and may offer a faster recovery. Ongoing research will assess the technical and pre-operative factors that influence procedural success and durability.