Reintervention for recurrence of mitral valve regurgitation: Transventricular beating heart neochordae implantation versus on-pump surgery

Objective Recurrence of mitral valve regurgitation after prior repair remains a challenge, even in experienced centers. Reoperation is associated with increased morbidity and mortality risks, prompting the exploration of less-invasive alternatives. This study aimed to compare outcomes in patients with failed mitral valve repair undergoing on-pump surgery versus micro-invasive re-repair surgery using neochordae (the NeoChord system). Methods Thirty-seven patients were retrospectively enrolled; 22 patients underwent on-pump surgery, and 15 patients underwent NeoChord repair. All patients had recurrent mitral valve prolapse after prior annuloplasty. The primary end point was freedom from a composite event, defined as mitral valve reoperation or the presence of moderate-or-severe mitral regurgitation at 1 year. All patients provided informed written consent for the publication of their data. Results Baseline characteristics, including mean age (63.9 ± 8.5 vs 67.5 ± 7.8 years, P = . 210), female gender (27.3% vs 26.7%, P > . 99), left ventricular ejection fraction (57.6% ± 8.2% vs 58.7% ± 4.3%, P = . 574), and European System for Cardiac Operative Risk Evaluation II (4.3% ± 2.9% vs 3.4% ± 1.4%, P = . 632), were comparable between the 2 groups. In the on-pump surgery group, 40.9% of surgeries were performed via sternotomy, and 54.5% required mitral valve replacement. All NeoChord procedures were successfully performed via left minithoracotomy. Operative time was significantly longer for on-pump surgery (310.2 ± 79.2 vs 146.1 ± 30.7 minutes, P < . 0001). There were no 30-day mortalities. One patient in the on-pump surgery group experienced a disabling stroke, and 1 patient in each group required reexploration for bleeding. Blood transfusion requirements were significantly higher with on-pump surgery (1.5 ± 2.1 vs 0.1 ± 0.5 units, P = . 012). Patients undergoing NeoChord procedure had significantly shorter ventilation times (12 vs 3 hours, P < . 0001) and hospital length-of-stay (6 vs 4 days, P < . 0001). Follow-up echocardiographic findings and cardiovascular readmissions were comparable between the 2 groups. Conclusions In patients with recurrent prolapse after mitral valve repair, NeoChord re-repair offers comparable 1-year outcomes to on-pump surgery, with significantly faster recovery and reduced transfusion needs.