Transapical mitral valve repair procedures: primetime for microinvasive
mitral valve surgery
Introduction: Nowadays micro-invasive procedures (off-pump, beating
heart) for mitral valve repair (MVRe) are abruptly expanding with the
potential to be adopted as a valuable alternative to surgery. In the
present manuscript, the Authors review the available technologies
intended to treat mitral regurgitation (MR) through transapical
approach, including annuloplasty and chordal repair options.
Annuloplasty: To date, Valcare Amend is the only transapical mitral
valve (MV) ring to have been implanted in patients. The device allows
for stabilization of the annulus through a complete semirigid D-shaped
ring. The first-in-human successful procedure was performed in 2016 by
our Group and subsequent clinical experience included a total of 14
implanted patients. Currently the technology is under clinical trial
evaluation to validate the efficacy and safety profile of the device.
Chordal Repair: Beating heart chordal implantation via trans-apical
approach is a current feasible, safe and reproducible option. Neochord
DS1000 is the most widely used technology in the field, with a solid
procedural experience and good results in well-selected patients. Its
clinical use has been validated in Europe since 2012, while it is still
under clinical investigation in the United States. Harpoon TDS-5 system
is a novel technology, recently CE mark approved for clinical use.
Conclusions: Transapical micro-invasive technologies are current viable
therapies to treat MR in selected patients. Embracing transcatheter MVRe
therapies should guide the cardiac surgeon through the new revolution of
micro-invasive MV tailored repair.