Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes.

BACKGROUND: The NeoChord echo-guided transapical beating heart repair is a promising early-stage minimally invasive surgical procedure for degenerative mitral valve (MV) regurgitation (DMR) correction. The technique has been improved since its inception following procedure standardization, patient selection optimization, and learning curve stabilization. We hereby present the mid-term clinical results through three years of our large single center experience. METHODS: All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both mitral leaflets that underwent the NeoChord procedure between November 2013 and June 2019 were included. Patients were categorized according to MV anatomy; Type A isolated central posterior leaflet prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular calcifications. Patients underwent clinical and echocardiographic follow-up at one, three, six, twelve months and yearly thereafter. Clinical outcomes and the composite primary endpoint (patient success) were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria. Mitral regurgitation (MR) severity was graded as absent, mild, moderate and severe according to American Society of Echocardiography (ASE) and European Society of Cardiology (ESC) guidelines. RESULTS: Two hundred and three patients were included; median follow-up was 24 months [interquartile range (IQR), 9-36]. Median age was 64 years (IQR, 54-74 years), median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) was 0.60% (IQR, 0.32-1.44%). There were 106 Type A patients (52.2%), 68 Type B (33.5%), 16 Type C (7.9%), and 13 Type D (6.4%). Kaplan-Meier estimate of survival was 99.0%±0.7% at one and two years and 94.0%±2.9% at three years. At one-year follow-up patient success was 91.2%±2.0% and 111 patients (74%) presented a residual MR mild or less (1+). At three-year follow-up patient success was 81.2%±3.8% and 32 patients (64%) had a residual MR mild or less (1+). Patient success was significantly different according to anatomical type (P=0.001). Echocardiographic analysis showed a significant acute left ventricle and left atrial reverse remodeling that was maintained up to three years. CONCLUSIONS: The NeoChord echo-guided transapical beating heart repair procedure demonstrated good clinical outcomes and echocardiographic results up to three-year follow-up.

Mecánica ventricular izquierda normal mediante ecocardiografía speckle tracking bidimensional. Valores de referencia para adultos sanos / Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults

Introducción y objetivos La ecocardiografía con speckle tracking bidimensional es un nuevo instrumento para evaluar la función del miocardio. El objetivo de este estudio fue evaluar los parámetros de rotación ystrain del ventrículo izquierdo mediante la ecocardiografía con speckle tracking bidimensional en un gran grupo de adultos sanos de una amplia gama de edades, con objeto de establecer los valores de referencia de dichos parámetros y determinar la influencia de la edad, el sexo y los factores hemodinámicos.MétodosSe realizaron ecocardiografías transtorácicas a 247 voluntarios sanos (139 mujeres; media de edad, 44 ± 16 [intervalo, 18-80] años). Efectuamos determinaciones de los valores de strainsistólico máximo longitudinal, circunferencial y radial, así como de la rotación y el giro del ventrículo izquierdo.ResultadosLos valores medios de strain total longitudinal, radial y circunferencial fueron -21,5% ± 2,0%, 40,1 ± 11,8% y -22,2 ± 3,4%, respectivamente. El strain longitudinal fue significativamente más negativo en las mujeres, mientras que el strain radial y el circunferencial y los parámetros rotacionales fueron similares en ambos sexos. En consecuencia, los límites inferiores de la normalidad para los componentes del strain fueron -16,9% en los varones y -18,5% en las mujeres para el strain longitudinal, -15,4% para el strain circunferencial y 24,6% para el strain radial, con independencia del sexo. Los valores de strain longitudinal fueron más negativos en la base que en los segmentos apicales. Los valores medios de la rotación fueron–6,9 ± 3,5° en la base, 13,0 ± 6,5° para la rotación apical y 20,0 ± 7,3° para el giro neto. Conclusiones Presentamos una evaluación detallada de la deformación normal del miocardio y la mecánica rotacional en una cohorte amplia de voluntarios sanos. Observamos que las mujeres presentan un strain longitudinal más negativo, lo cual explica su mayor fracción de eyección del ventrículo izquierdo. La disponibilidad de valores de referencia de esos parámetros puede facilitar su aplicación en la práctica clínica habitual

Introduction and objectives Two-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors.MethodsTransthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist.ResultsAverage values of global longitudinal, radial, and circumferential strain were -21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and -22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were -16.9% in men and -18.5% in women for longitudinal strain, and -15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were -6.9° (standard deviation, 3.5°) for the base, 13.0° (standard deviation, 6.5°) for apical rotation, and 20.0° (standard deviation, 7.3°) for net twist. Conclusions: We report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine

Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults.

INTRODUCTION AND OBJECTIVES: Two-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors. METHODS: Transthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist. RESULTS: Average values of global longitudinal, radial, and circumferential strain were -21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and -22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were -16.9% in men and -18.5% in women for longitudinal strain, and -15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were -6.9° (standard deviation, 3.5°) for the base, 13.0° (standard deviation, 6.5°) for apical rotation, and 20.0° (standard deviation, 7.3°) for net twist. CONCLUSIONS: We report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine.