Feasibility of concomitant exclusion of left atrial appendage during novel transapical off-pump beating heart mitral valve repair.

IF 1.1 4区 医学 Q4 ENGINEERING, BIOMEDICAL
Journal of Artificial Organs Pub Date : 2024-03-01 Epub Date: 2023-02-08 DOI:10.1007/s10047-023-01383-2
Daniel Tai-Leung Chan, Inderjeet Bhatia, Simon Chi-Cheung Lam, Timmy Wing-Kuk Au
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引用次数: 0

Abstract

The AtriClip device enables the safe and reproducible epicardial clipping of the left atrial appendage. Transapical off-pump beating heart mitral valve repair using NeoChord DS100 Artificial Chordae Delivery System has matured and become more standardized. We aim to evaluate the feasibility of combining NeoChord repair and left atrial appendage exclusion in a single procedure through the same minithoracotomy in patients with mitral valve prolapse and atrial fibrillation. From 2018 to 2019, seven patients with severe mitral regurgitation and atrial fibrillation underwent transesophageal echocardiography-guided transapical off-pump mitral valve repair with the novel NeoChord DS 1000 system and concomitant left atrial appendage exclusion using the AtriClip Pro II device. Both procedures were performed via left mini-thoracotomy. The AtriClip device was applied after the NeoChord repair was done. All seven patients had less than moderate mitral regurgitation after the NeoChord repair and successful left atrial appendage occlusion. There were no device or procedure-related complications. Clinical follow-up revealed significant symptomatic improvement, and no cardiovascular complications were reported. Transesophageal echocardiography at 6-12 months post-procedure showed stable left atrial appendage occlusion with no residual flow between the left atrium and the left atrial appendage and a stump of less than 5 mm. Beating heart epicardial clipping of the left atrial appendage using AtriClip concomitant with transapical mitral valve repair using Neochord DS 1000 system is a feasible and safe treatment option in mitral valve prolapse and atrial fibrillation in patients with limited indications. However, its safety needs to be confirmed in a larger series of patients.

Abstract Image

在新型经心尖离泵心脏跳动二尖瓣修复术中同时切除左房阑尾的可行性。
AtriClip 设备可以安全、可重复地从心外膜剪切左心房阑尾。使用 NeoChord DS100 人工腱索输送系统进行经皮腔外心脏跳动二尖瓣修复术已日趋成熟和标准化。我们旨在评估在二尖瓣脱垂和心房颤动患者中,通过同一小胸腔切口将NeoChord修复术和左心房阑尾切除术结合在一次手术中的可行性。从2018年到2019年,7名患有严重二尖瓣反流和心房颤动的患者在经食道超声心动图引导下接受了新型NeoChord DS 1000系统的经心尖离泵二尖瓣修复术,并同时使用AtriClip Pro II装置进行了左心房阑尾排除术。这两项手术均通过左小胸腔切口进行。在完成 NeoChord 修复后再使用 AtriClip 装置。所有七名患者在完成 NeoChord 修复术并成功封堵左心房阑尾后,二尖瓣反流程度均低于中度。没有出现与装置或手术相关的并发症。临床随访显示症状明显改善,未报告心血管并发症。术后6-12个月的经食道超声心动图显示左房阑尾闭塞情况稳定,左心房和左房阑尾之间无残留血流,残端小于5毫米。在使用Neochord DS 1000系统进行经心尖二尖瓣修复术的同时,使用AtriClip对左心房阑尾进行心外膜跳动式剪切是治疗二尖瓣脱垂和心房颤动的一种可行且安全的方法,适用于适应症有限的患者。然而,其安全性还需要在更大范围的患者中得到证实。
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来源期刊
Journal of Artificial Organs
Journal of Artificial Organs 医学-工程:生物医学
CiteScore
2.80
自引率
15.40%
发文量
68
审稿时长
6-12 weeks
期刊介绍: The aim of the Journal of Artificial Organs is to introduce to colleagues worldwide a broad spectrum of important new achievements in the field of artificial organs, ranging from fundamental research to clinical applications. The scope of the Journal of Artificial Organs encompasses but is not restricted to blood purification, cardiovascular intervention, biomaterials, and artificial metabolic organs. Additionally, the journal will cover technical and industrial innovations. Membership in the Japanese Society for Artificial Organs is not a prerequisite for submission.
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