NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status Awaiting development
Technology type Procedure
Decision Selected
Reason for decision Anticipate the topic will be of importance to patients, carers, professionals, commissioners and the health of the public to ensure clinical benefit is realised, inequalities in use addressed, and help them make the best use of NHS resources
Process IP
ID number 1889
Description The procedure is performed on a beating heart with no need for cardiopulmonary bypass. With the patient under general anaesthesia, and transoesophageal echocardiography (TOE) a small incision (anterior thoracotomy) is made on the left side of the chest between the ribs. An introducer is inserted few cm from the apex of the left ventricle at the base of the papillary muscles between the branches of the left coronary artery (lateral to the left anterior descending artery). Then the device delivery system is advanced via the introducer and is navigated to the collapsed/prolapsed target mitral valve leaflet. Once positioning of the tip of the delivery system is confirmed on TOE imaging, it is activated by depressing the plunger on the device. This releases a needle with the synthetic cord which is deployed/anchored to the surface of the target mitral valve leaflet. The delivery system is removed from the introducer and suture is tightened. Additional chordae (up to 4) can be placed based on pre-operative or intra-operative assessment using the same introducer. The tension on the chords is adjusted under TOE guidance until there is improvement or elimination of the mitral regurgitation. Once confirmed on imaging the endings of the chord sutures are then secured to the pericardium. It preserves the ability to perform future mitral valve repair.

Provisional Schedule

IPAC 1 13 October 2022
Interventional procedure consultation 24 November 2022 - 04 January 2023
IPAC 2 09 February 2023
Expected publication 21 April 2023

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Timeline

Key events during the development of the guidance:

Date Update
11 May 2022 Awaiting development. Status change linked to Topic Selection Decision being set to Selected
13 January 2022 Topic selection. IPAC 0

For further information on how we develop interventional procedures guidance, please see our IP manual