Acute intraoperative echocardiographic changes after transapical off-pump mitral valve repair with NeoChord implantation

•NeoChord Mitral Valve (MV) repair results in immediate physiological restoration of the MV anatomy in patients with degenerative MV disease while respecting the dynamic shape of MV.•These acute intraoperative changes, in particular the reduction of AP diameter, are associated with procedure durability at 1-year follow-up.•The physiological annular shape restoration is significantly greater than what described with other leaflet repair therapies demonstrating that the underlying mechanism is the acute ventricular and atrial volume reduction determined by the mitral regurgitation correction.