title: Transapical off-pump mitral valve repair with Neochord implantation: Early clinical results.
abstract: BACKGROUND
  This prospective study aims to assess early clinical outcomes in patients undergoing Transapical Off-Pump Mitral Valve Intervention with Neochord Implantation (TOP-MINI).
  
  
  RESULTS
  Forty-nine patients with severe symptomatic degenerative mitral regurgitation (MR) were treated. Median age was 72 years (IQR 58-78) and median Euroscore-I was 3.26% (IQR 0.88-8.15). Forty-four patients (89.8%) presented with posterior leaflet prolapse (LP), 4 (8.2%) with anterior LP and 1 (2%) with combined disease. Acute procedure success (defined as successful placement of at least 3 neochords with reduction of residual MR to less than 2+) was achieved in all patients. In-hospital mortality was 2%. At 30 days major adverse events included one AMI (2%) successfully treated percutaneously and one sepsis (2%), no stroke or bleeding events occurred. At 3 months overall survival was 98%. MR was absent in 16 patients (33.4%), was grade 1+ in 15 (31.2%), and was grade 2+ in 12 (25%). Five patients (10.4%) developed recurrent severe MR due to anterior native chordae rupture. Four of them were successfully re-operated. At 3 months follow-up freedom from reoperation was 91.7 ± 4%.
  
  
  CONCLUSIONS
  Early results with Neochord procedure indicate that TOP-MINI is feasible and safe. Efficacy is maintained up to 3 months follow-up with significant clinical benefit for the patients.
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy. Electronic address: colli.andrea.bcn@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Manzan
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Zucchetta
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Bizzotto
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Besola
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bagozzi
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellu
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Sarais
authors.affiliation: Institute of Anesthesia, Department of Medicine, University of Padua, Italy.
authors.forename: Demetrio
authors.initials: D
authors.lastname: Pittarello
authors.affiliation: Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D002815:Chordae Tendineae / Q000000981:diagnostic imaging* / Q000601:surgery*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Mitral valve regurgitation; Mitral valve repair; Off-pump; Transapical