Transapical mitral valve repair procedures: primetime for microinvasive mitral valve surgery

Introduction: Nowadays micro-invasive procedures (off-pump, beating heart) for mitral valve repair (MVRe) are abruptly expanding with the potential to be adopted as a valuable alternative to surgery. In the present manuscript, the Authors review the available technologies intended to treat mitral regurgitation (MR) through transapical approach, including annuloplasty and chordal repair options. Annuloplasty: To date, Valcare Amend is the only transapical mitral valve (MV) ring to have been implanted in patients. The device allows for stabilization of the annulus through a complete semirigid D-shaped ring. The first-in-human successful procedure was performed in 2016 by our Group and subsequent clinical experience included a total of 14 implanted patients. Currently the technology is under clinical trial evaluation to validate the efficacy and safety profile of the device. Chordal Repair: Beating heart chordal implantation via trans-apical approach is a current feasible, safe and reproducible option. Neochord DS1000 is the most widely used technology in the field, with a solid procedural experience and good results in well-selected patients. Its clinical use has been validated in Europe since 2012, while it is still under clinical investigation in the United States. Harpoon TDS-5 system is a novel technology, recently CE mark approved for clinical use. Conclusions: Transapical micro-invasive technologies are current viable therapies to treat MR in selected patients. Embracing transcatheter MVRe therapies should guide the cardiac surgeon through the new revolution of micro-invasive MV tailored repair.