{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T03:17:17Z","timestamp":1782962237070,"version":"3.54.5"},"reference-count":28,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The NeoChord procedure is a trans-ventricular, echo-guided, beating-heart mitral valve (MV) repair technique used to treat degenerative mitral regurgitation (MR) caused by leaflet prolapse and\/or flail. Objectives: This study aimed to develop a machine learning (ML) scoring system using pre-procedural clinical and echocardiographic variables to predict the success of the NeoChord procedure\u2014defined as less than moderate MR at follow-up. Methods: A total of 80 patients were included. Preoperative MV anatomical parameters were assessed using three-dimensional (3D) transesophageal echocardiography and analyzed with dedicated post-processing software (QLAB software, version 15.0, Philips Healthcare, Amstelveen, NL, The Netherlands). Two supervised ML models (random forest and decision tree) were trained on the dataset, with hyperparameters optimized via 10-fold cross-validation. The random forest model also provided a variable importance ranking using a filter-based method. Key predictors identified by the models included age, flail gap, early systolic mitral valve area, and indexed left atrial volume. Results: The mean and median cross-validated area under the curve of the ML models were 0.79 and 0.83 for the random forest model and 0.72 and 0.77 for the decision tree model, respectively. Conclusions: A machine learning approach integrating clinical and 3D echocardiographic parameters can effectively predict mid-term procedural success of the NeoChord technique. This method may support future preoperative patient selection, pending validation in larger cohorts.<\/jats:p>","DOI":"10.3390\/jcm14165863","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T13:08:51Z","timestamp":1755608931000},"page":"5863","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Machine Learning Approach to Predict Successful Trans-Ventricular Off-Pump Micro-Invasive Mitral Valve Repair"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8848-3198","authenticated-orcid":false,"given":"Alessandro","family":"Vairo","sequence":"first","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Russo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9475-1507","authenticated-orcid":false,"given":"Andrea","family":"Saglietto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rino Andrea","family":"Cimino","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3728-4863","authenticated-orcid":false,"given":"Marco","family":"Pocar","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3431-9143","authenticated-orcid":false,"given":"Cristina","family":"Barbero","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0231-1545","authenticated-orcid":false,"given":"Andrea","family":"Costamagna","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia and Critical Care, Department of Surgical Sciences, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4940-0876","authenticated-orcid":false,"given":"Gaetano Maria","family":"De Ferrari","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, 10126 Turin, Italy"},{"name":"Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1032-9155","authenticated-orcid":false,"given":"Stefano","family":"Salizzoni","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"i3","DOI":"10.1093\/ejechocard\/jeq153","article-title":"Anatomy of the mitral valve: Understanding the mitral valve complex in mitral regurgitation","volume":"11","author":"McCarthy","year":"2010","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_2","first-page":"151","article-title":"Anatomy of the Mitral Valve Apparatus. Role of 2D and 3D Echocardiography","volume":"31","author":"Levine","year":"2013","journal-title":"Cardiol. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"R63","DOI":"10.1530\/ERP-15-0008","article-title":"Quantitative mitral valve anatomy and pathology","volume":"2","author":"Garbi","year":"2015","journal-title":"Echo Res. Pr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4053","DOI":"10.1111\/jocs.16011","article-title":"Transapical mitral valve repair procedures: Primetime for microinvasive mitral valve surgery","volume":"37","author":"Fiocco","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.jacc.2013.07.090","article-title":"Off-Pump Transapical Implantation of Artificial Neo-Chordae to Correct Mitral Regurgitation: The tact trial (transapical artificial chordae tendinae) proof of concept","volume":"63","author":"Seeburger","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1093\/icvts\/ivv014","article-title":"Acute safety and efficacy of the NeoChord procedure","volume":"20","author":"Colli","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Fiocco, A., Nadali, M., Speziali, G., and Colli, A. (2019). Transcatheter Mitral Valve Chordal Repair: Current Indications and Future Perspectives. Front. Cardiovasc. Med., 6.","DOI":"10.3389\/fcvm.2019.00128"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1093\/ejcts\/ezy064","article-title":"An early European experience with transapical off-pump mitral valve repair with NeoChord implantation","volume":"54","author":"Colli","year":"2018","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"131","DOI":"10.21037\/acs-2020-mv-86","article-title":"Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes","volume":"10","author":"Gerosa","year":"2021","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_11","first-page":"165","article-title":"Imaging of Mitral Valve Prolapse: What Can We Learn from Imaging about the Mechanism of the Disease?","volume":"2","author":"Durst","year":"2015","journal-title":"J. Cardiovasc. Dev. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s11886-019-1145-5","article-title":"Mitral Valve Pathology","volume":"21","author":"Fishbein","year":"2019","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ijcard.2018.01.049","article-title":"Prognostic impact of leaflet-to-annulus index in patients treated with transapical off-pump echo-guided mitral valve repair with NeoChord implantation","volume":"257","author":"Colli","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1016\/j.amjcard.2006.12.072","article-title":"Annular-to-Leaflet Mismatch and the Need for Reductive Annuloplasty in Patients Undergoing Mitral Repair for Chronic Mitral Regurgitation Due to Mitral Valve Prolapse","volume":"99","author":"Maisano","year":"2007","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"122","DOI":"10.21037\/acs-2020-mv-96","article-title":"Combining echocardiographic and anatomic variables to predict outcomes of mitral valve repair with the NeoChord procedure","volume":"10","author":"Manzan","year":"2021","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vairo, A., Gaiero, L., Marro, M., Russo, C., Bolognesi, M., Soro, P., Gallone, G., Fioravanti, F., Desalvo, P., and D\u2019ascenzo, F. (2023). New Echocardiographic Parameters Predicting Successful Trans-Ventricular Beating-Heart Mitral Valve Repair with Neochordae at 3 Years: Monocentric Retrospective Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12051748"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1093\/ejcts\/ezy046","article-title":"Learning curve analysis of transapical NeoChord mitral valve repair","volume":"54","author":"Colli","year":"2018","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_18","unstructured":"Nussinovitch, U. (2020). Chapter 21\u2014Transcatheter mitral valve therapies for degenerative and functional mitral regurgitation. Emerging Technologies for Heart Diseases, Academic Press."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/ehjdh\/ztae080","article-title":"Machine learning based prediction models for cardiovascular disease risk using electronic health records data: Systematic review and meta-analysis","volume":"6","author":"Liu","year":"2025","journal-title":"Eur. Hearth J. Digit. Health"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Chowdhury, M.A., Rizk, R., Chiu, C., Zhang, J.J., Scholl, J.L., Bosch, T.J., Singh, A., Baugh, L.A., McGough, J.S., and Santosh, K. (2025). The Heart of Transformation: Exploring Artificial Intelligence in Cardiovascular Disease. Biomedicines, 13.","DOI":"10.3390\/biomedicines13020427"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e13743","DOI":"10.1111\/acel.13743","article-title":"Acetyltransferase p300 regulates atrial fibroblast senescence and age-related atrial fibrosis through p53\/Smad3 axis","volume":"22","author":"Gao","year":"2023","journal-title":"Aging Cell"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jcmg.2020.09.012","article-title":"Can Left Atrial Strain Forecast Future Fibrillation?","volume":"14","author":"Gorcsan","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.ijcard.2016.06.197","article-title":"Left atrial strain: A useful index in atrial fibrillation","volume":"220","author":"Cameli","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jacc.2018.10.067","article-title":"Long-Term Implications of Atrial Fibrillation in Patients with Degenerative Mitral Regurgitation","volume":"73","author":"Grigioni","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"El Mathari, S., Kluin, J., Hopman, L.H.G.A., Bhagirath, P., Oudeman, M.A.P., Vonk, A.B.A., Nederveen, A.J., Eberl, S., Klautz, R.J.M., and Chamuleau, S.A.J. (2023). The role and implications of left atrial fibrosis in surgical mitral valve repair as assessed by CMR: The ALIVE study design and rationale. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1166703"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Park, M.H., Zhu, Y., Imbrie-Moore, A.M., Wang, H., Marin-Cuartas, M., Paulsen, M.J., and Woo, Y.J. (2021). Heart Valve Biomechanics: The Frontiers of Modeling Modalities and the Expansive Capabilities of Ex Vivo Heart Simulation. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.673689"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.echo.2019.01.003","article-title":"Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance","volume":"32","author":"Zoghbi","year":"2019","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Loardi, C.M., Nagata, Y., and Thiene, G. (2023). 3D Echocardiography in Mitral Valve Prolapse. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1050476"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5863\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:30:58Z","timestamp":1760034658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5863"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,19]]},"references-count":28,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165863"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165863","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,19]]}}}