Abstract
Mitral valve repair (MVR) is undisputedly associated with better
clinical and functional outcomes than any other type of valve
substitute. Conventional mitral valve surgery in dedicated high-volume
centers can assure excellent results in terms of mortality and freedom
from mitral regurgitation (MR) recurrence but requires cardiopulmonary
bypass (CPB) and cardioplegic heart arrest. Trying to replicate the
percentage of success of surgical MVR is the aim of all new
transcatheter mitral dedicated devices. In particular transapical
beating-heart mitral valve repair by artificial chordae implantation
with transesophageal echocardiography (TEE) guidance is an expanding
field. The safety and feasibility of the procedure have already been
largely demonstrated with Neochord and more recently with Harpoon
systems. Wang et al. present the outcomes of the first-in-human
experience using a novel artificial chordae implantation device, the
Mitralstitch system. Despite a quite small cohort of only 10 patients
treated, 1-year results are satisfying and comparable to the early
experience with former devices (4 patients with moderate or more MR
recurrence). The comparison with surgical MVR is still unfavorable and
requires further studies and significant procedure improvement. However,
the device permits the treatment of anterior and posterior leaflets
prolapse and performs quite easily edge-to-edge reparation. It will be
interesting to evaluate longer follow-up in larger cohorts of patients
as well as the possibility to shift to the transfemoral approach.