The role of X-ray navigation in transapical implantation of mitral neochords for significant mitral regurgitation on the beating heart

Introduction. X-ray navigation in modern cardiac surgery is a revolutionary technology that allows to increase the accuracy and safety of cardiac surgeries significantly. Currently, navigation under direct X-ray control in surgeries to restore the mitral valve chords is used only when implanting chords using the ChordArt method. In addition, X-ray navigation and external implantation of the mitral neochord are used in such methods of mitral regurgitation correction as MitraClip and transcatheter mitral valve replacement (TMVR).

The objective. To systematically review the scientific evidence on the use of radiographic navigation in mitral valve interventions in case of significant mitral regurgitation. To identify radiographic projections that allow the most accurate visualization of cardiac structures required for neochords implantation.

Materials and methods. An analysis of studies devoted to the use of X-ray navigation in transapical implantation of mitral neochords for significant mitral regurgitation on the beating heart was performed. The search was performed in the PubMed and Elibrary databases from 2009 to 2024 using the following keywords: “mitral valve”, “mitral regurgitation”, “X-ray navigation”, “cardiovascular surgery”, “transapical chord repair”, “transcatheter interventions”, “coronary sinus”, “circumflex artery”, “MitraClip”, “TMVR – Transcatheter Mitral Valve Repair” using AND, OR operators.

Results. A total of 257 articles were analyzed, 65 of which were used to compile the review. The analysis revealed that the main method of visualizing instruments in the heart cavities during interventions on the mitral valve is intraoperative fluoroscopy. The most acceptable projections for performing surgery on transapical implantation of mitral neochords in case of significant mitral regurgitation on a beating heart were determined.

Conclusion. The results of the conducted analysis showed that X-ray navigation is an integral method of intraoperative navigation, which should be used during transapical implantation of mitral neochords in case of significant mitral regurgitation on a beating heart.

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