title: Transapical endovascular implantation of neochordae using a suction and suture device.
abstract: OBJECTIVE
  Neochordae implantation is a standard method for treatment of mitral valve prolapse. We describe a transcatheter technology enabling transapical endovascular chordal implantation.
  
  
  METHODS
  Six adult pigs were anesthetized. Two 10F sheaths were introduced in the femoral vessels for monitoring and intracardiac echo. After midline sternotomy, the pericardium was opened, the apex was punctured inside two 2-0 polypropylene purse strings. A 0.035 in J tipped guidewire was introduced in the left ventricle and an ultra stiff 14F sheath (guide catheter) inserted through the apex. A suction-and-suture device was introduced in the left ventricle. The mitral valve was crossed under echo guidance. Using suction, either the anterior (two cases) or posterior (four cases) leaflet was captured and a loop of 4-0 polypropylene was thrown at the edge of the leaflet. The loop, with a pledget, was exteriorized through the introducer. The introducer was removed and the purse-string tied. Under echo guidance, the neochordae suture was pulled and tied over a pledget to evoke leaflet tethering. The animals were sacrificed and gross anatomy reviewed.
  
  
  RESULTS
  Leaflet capture was feasible in the intended location in all cases. Following suture tethering, variable degrees of MR were obtained. At gross anatomy, the neochordae were positioned at 1-4mm from the leaflet free edge, and were firmly attached to the leaflets.
  
  
  CONCLUSIONS
  Transcatheter endovascular neochordae implantation is feasible. A prolapse model is needed to further demonstrate feasibility under pathologic conditions. The apical approach allows easy and direct route to transcatheter beating heart minimally invasive mitral repair.
authors.affiliation: San Raffaele Cardio-Thoracic and Vascular Department, Milano, Italy. francesco.maisano@hsr.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Stanton
authors.initials: S
authors.lastname: Rowe
authors.forename: Alessandro
authors.initials: A
authors.lastname: Addis
authors.forename: Marino
authors.initials: M
authors.lastname: Campagnol
authors.forename: Andrea
authors.initials: A
authors.lastname: Guidotti
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000818:Animals; D002815:Chordae Tendineae / Q000637:transplantation*; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods; D013396:Suction / Q000295:instrumentation; D034421:Sus scrofa; D013536:Suture Techniques / Q000295:instrumentation