J Thorac Cardiovasc Surg. 2026 Feb 26:S0022-5223(26)00174-1. doi: 10.1016/j.jtcvs.2026.01.036. Online ahead of print.
ABSTRACT
OBJECTIVE: Mitral valve repair (MVr) is the standard treatment for degenerative mitral regurgitation (MR). However, MR may recur, and reoperation is associated with increased mortality and technical complexity. Micro-invasive MVr using the NeoChord technique in redo setting is performed off-pump, offering clear advantages, particularly in high-risk patients.
METHODS: This retrospective, multicenter, international registry included 92 patients treated with NeoChord between 2014 and 2025 for recurrent MR following prior MVr across 32 centers. The primary composite endpoint was freedom from recurrence of severe MR, need for reintervention due to technical failure, and 30-day or cardiovascular mortality.
RESULTS: NeoChord repair was successful in 91 patients (98.9%); one was converted to open surgery. Mean age was 64.6±11.6; 22 patients (23.9%) were female. Mean left ventricle ejection fraction was 57.4±8.1%; EuroSCORE II was 4.3±3.2%. A median of three chords was implanted. Mean procedural time was 139±65 minutes. At discharge, MR was ≤mild in 93.5%. One patient (1.1%) died on day eight. One life-threatening bleeding and one acute myocardial infarction were reported. Median hospital length-of-stay was five days; 47.8% were extubated in the operating room. The primary endpoint was achieved in 81.3±6.6% of patients at 5-year (Kaplan-Meier analysis). Seven patients (8.6%) underwent re-reintervention; three remained with severe MR. In the multivariate analysis older age was associated with an increased risk (HR=1.160,95%CI:1.021-1.317), while higher hemoglobin levels were protective (HR=0.423,95%CI:0.233-0.768).
CONCLUSIONS: Micro-invasive NeoChord repair provides excellent procedural and 5-year outcomes with very low mortality, supporting its role as a valuable option for reoperative mitral valve surgery.
PMID:41763387 | DOI:10.1016/j.jtcvs.2026.01.036