Multicenter European Experience of the Echo Guided Off-Pump Transapical Mitral Valve Repair

Introduction: Transapical off-pump mitral valve repair with neochordae implantation (TOP-MINI) is a new transcatheter procedure for degenerative mitral valve regurgitation (MR) due mitral leaflet prolapse. Hypothesis: This retrospective, multi-center study has the aim to evaluate 1-year clinical results of the TOP-MINI procedure in a consecutive cohort of patients treated for posterior leaflet prolapse. Methods: Between February 2013 and May 2016, 142 patients were included in the Neochord Independent International Registry. All patients had severe MR due to flail/prolapse of posterior mitral leaflet, with isolated central posterior disease (Type A) or multisegment posterior leaflet disease (Type B). Primary endpoint, was defined, according to MVARC criteria, as composite of procedural success, freedom from mortality, stroke, re-intervention, recurrence of severe MR, re-hospitalization and a decrease of at least 1 NYHA class. We also compared outcomes according to anatomical type classification. Results: Median age was 65.5 years (IQR 54-75), median Euroscore-II 1.06% (IQR 0.67-1.74). Type A and B patients were 45 (32%), 97 (68%) respectively. A median of 4 chordae (IQR 4-5) were implanted. Procedure success was achieved in 139 patients (98%). Eighty-five (60%) completed the 1-year follow-up. Overall 1-year survival was 98.5±1.1%. Freedom from MR u003e2+ was 90±2.8% for overall population and 96.2±3.8% and 87±3.7% for Type A and Type B (p=0.042). Freedom from Redo was 93.6±2.4% for overall population and 96.2±3.8% and 92.5±3% for Type A and Type B respectively (p=0.33) (Figure). Primary endpoint was achieved in 89±2.9% for the overall population, and 96.2±3.8% and 85.9±3.8% for Type A and Type B respectively ( p =0.032) Conclusions: TOP-MINI is a safe, effective and reproducible procedure. Clinical and echocardiographic efficacy is maintained up to 1-year with significative differences between patients with one-segment and multi-segment disease.