Microinvasive, off-pump, transventricular neochordae implantation in recurrent mitral valve regurgitation after open heart surgical repair

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. Microinvasive 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 the NeoChord technique between 2014 and 2025 for recurrent MR after previous MVr across 32 centers. The primary composite end point 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%; European System for Cardiac Operative Risk Evaluation was 4.3 ± 3.2%. A median of 3 chords was implanted. Mean procedural time was 139 ± 65 minutes. At discharge, MR was mild or less in 93.5%. One patient (1.1%) died on day 8. One life-threatening bleeding and one acute myocardial infarction were reported. Median hospital length-of-stay was 5 days; 47.8% of patients were extubated in the operating room. The primary end point was achieved in 81.3 ± 6.6% of patients at 5 years (Kaplan-Meier analysis). Seven patients (8.6%) underwent re-reintervention; 3 remained with severe MR. In the multivariate analysis, older age was associated with an increased risk (hazard ratio, 1.160; 95% CI, 1.021-1.317), whereas greater hemoglobin levels were protective (hazard ratio, 0.423; 95% CI, 0.233-0.768). CONCLUSIONS: Microinvasive 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.