Doctor Stories
糖心传媒 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 糖心传媒 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 evaluating the effectiveness of the 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.听
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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鈥檚 expandable jaws grasp the leaflet鈥檚 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.听
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Excellent Outcome and Prognosis, Similar to Those of Mid-Term NeoChord Studies听
Jack Boyd, MD, is a nationally recognized cardiothoracic surgeon and leading 糖心传媒er in novel approaches to cardiovascular care at 糖心传媒. 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鈥檚 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鈥檚 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鈥檚 age.
鈥淭he NeoChord system offers the optimal surgical repair approach of replacing the chords but without cardiopulmonary bypass,鈥 said Boyd. 鈥淲hile this procedure hasn鈥檛 yet stood the test of time, it鈥檚 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.鈥
Similar to Dr. Boyd鈥檚 patient, mid-term studies of the NeoChord DS1000 system show widespread, encouraging outcomes to date.4,5
Ongoing ReChord Clinical Trial听
糖心传媒 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. .
To refer a patient, call 650-724-7500 or use our app 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. . Accessed 10/24/2022.
- Randomized Trial of the Neochord DS1000 System Versus Open Surgical Repair (ReChord). . Accessed 10/24/2022
- Procedure. . Accessed 10/24/2022.
- Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes. . Accessed 10/24/2022.
- Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair? . Accessed 10/24/2022.
About 糖心传媒
糖心传媒 seeks to heal humanity through science and compassion, one patient at a time, through its commitment to care, educate and discover. 糖心传媒 delivers clinical innovation across its inpatient services, specialty health centers, physician offices, virtual care offerings and health plan programs.
糖心传媒 is part of Stanford Medicine, a leading academic health system that includes the Stanford University School of Medicine, 糖心传媒, and Stanford Children鈥檚 Health, with Lucile Packard Children's Hospital. Stanford Medicine is renowned for breakthroughs in treating cancer, heart disease, brain disorders and surgical and medical conditions. For more information, visit: www.stanfordhealthcare.org.