Doctor Stories
Stanford Health Care is First in the Western U.S. to Complete Transapical Off-Pump Mitral Valve Repair
12.15.2022
In 2016, a man in his late 50s came to Stanford Health Care with severe chronic degenerative mitral regurgitation (MR) from mitral leaflet prolapse. The patient previously rode his bicycle multiple times per week, participated in competitive spinning classes, and lifted weights. Exercise was an important part of his identity, but mitral valve insufficiency restricted his ability to participate in the activities he enjoyed.
While open-heart surgery is the gold standard for resolving severe chronic degenerative MR1, it requires a sternotomy or thoracotomy and cardiopulmonary bypass. The patient met the criteria for the ReChord clinical trial evaluating the effectiveness of the NeoChord™ DS1000™ System for treating MR.2 Accessing the heart by small left chest incision to access the heart, the NeoChord Artificial Chordae Delivery System facilitates chordae implantation in beating hearts without opening them.
The patient was eager to participate in the ReChord trial. In July 2017, Boyd performed the first beating-heart mitral valve repair in the western U.S.
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How Beating-Heart Mitral Valve Repair Works Using the NeoChord DS1000 System3
Using 2D- and 3D-transesophageal echocardiography (TEE) guidance, the surgeon inserts the NeoChord DS1000 system through the left ventricle and navigates to the mitral annular plane.
The system’s expandable jaws grasp the leaflet’s prolapsing segment, and an external monitor confirms a secure hold. The surgeon places several chordae made of expanded polytetrafluoroethylene (ePTFE) in the leaflet to re-suspend it.
Use TEE to adjust the chordae length to eliminate the regurgitation, the surgeon then secures the chordae to a pledget on the epicardium.
Excellent Outcome and Prognosis, Similar to Those of Mid-Term NeoChord Studies
Jack Boyd, MD, is a nationally recognized cardiothoracic surgeon and leading researcher in novel approaches to cardiovascular care at Stanford Health Care. Boyd is the first surgeon in the western United States to use a minimally invasive, off-pump surgical technique to treat degenerative mitral valve regurgitation due to prolapse.
After the two-hour procedure, Boyd’s team extubated the patient in the operating room, and he was awake the same day. The next day he climbed a flight of stairs with less shortness of breath than before. In four days, the patient went home, a few days earlier than the average stay for open-heart surgery.
A couple of weeks after surgery, the patient was walking 3 to 4 miles in less than an hour. Within two months of surgery, when his incisional pain abated, he was back to riding his bike, spinning, and lifting some light weights.
Now, five years after his procedure, the patient’s long-term prognosis is excellent. Through serial echocardiograms, Boyd can see that the repair is lasting, and the patient reports feeling well. Extrapolating data from open-heart approaches to mitral valve chordal repair, Boyd and his team expect a normal life expectancy for someone of the patient’s age.
“The NeoChord system offers the optimal surgical repair approach of replacing the chords but without cardiopulmonary bypass,” said Boyd. “While this procedure hasn’t yet stood the test of time, it’s so similar to the standard surgical procedure that we think it will be a lasting and excellent option for people who would benefit from mitral valve repair.”
Similar to Dr. Boyd’s patient, mid-term studies of the NeoChord DS1000 system show widespread, encouraging outcomes to date.4,5
Ongoing ReChord Clinical Trial
Stanford Health Care is accepting candidates for the NeoChord DS1000 clinical trial (ReChord), with Boyd as principal investigator. Patients must have moderate or severe degenerative mitral valve regurgitation. Learn more.
To refer a patient, call 650-724-7500 or use our app CVH Flare referral portal and online directory.
If you have questions, please contact Jesus (Jesse) Perez, market outreach executive liaison, at 650-353-8063 or jesusperez@stanfordhealthcare.org.
References:
- 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, September 2017. Accessed 10/24/2022.
- Randomized Trial of the Neochord DS1000 System Versus Open Surgical Repair (ReChord). ClinicalTrials.gov. Accessed 10/24/2022
- Procedure. NeoChord website. Accessed 10/24/2022.
- Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes. Annals of Cardiothoracic Surgery, January 2021. Accessed 10/24/2022.
- Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair? The Anatolian Journal of Cardiology, July 2021. Accessed 10/24/2022.
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