Off-pump minimal access mitral valve repair by artificial chordae insertion to treat mitral regurgitation

This transcatheter (minimal access) procedure for mitral regurgitation is done under general anaesthesia on a beating heart with no need for cardiopulmonary bypass (off-pump). Using transoesophageal echocardiography imaging, a left-sided anterior thoracotomy is used to access the left ventricle. The device delivery system is passed through the wall of the left ventricle with purse-string sutures, into the left side of the heart to the target mitral valve leaflet. Once it is correctly positioned, artificial chordae are passed through the target mitral valve using a needle and anchored to the leaflet. Typically, 3 to 4 chordae are placed along the free edge of the mitral valve leaflet to re-suspend the prolapsed segment. The delivery system is removed, and the purse-string suture is tightened. The tension on the chordae is adjusted until there is improvement or elimination of the mitral regurgitation, as confirmed on transoesophageal echocardiography imaging. The endings of the chordae sutures are then secured to the outside of the heart.

This procedure has a lower risk of compromising subsequent surgical mitral valve repair than some other transcatheter techniques for mitral regurgitation. It may also be suitable for people for whom open-heart surgery is not considered safe because of other health conditions.