Minimally invasive mitral valve repair in Barlow's disease: Early and long-term results

Abstract

Barlow's disease remains a challenging surgical pathology in patients presenting with mitral regurgitation. We reviewed our early and long-term results for patients with Barlow's disease who underwent minimally invasive mitral valve surgery. Between 1999 and 2010, 145 patients with Barlow's disease underwent minimally invasive mitral valve repair at Leipzig Heart Center. Preoperative echocardiography and intraoperative valve analysis confirmed annular dilatation, bileaflet prolapse, and excessive leaflet tissue in all cases. We retrospectively reviewed mitral valve repair techniques, early and late postoperative clinical outcomes, and follow-up echocardiographic data. Successful mitral valve repair was performed in 94.5% of patients (n=137), initial mitral valve replacement was performed in 2.8% of patients (n=4), and mitral valve replacement after unsuccessful mitral valve repair was performed in 2.8% of patients (n=4). Mean aortic crossclamp time was 99±33 minutes, cardiopulmonary bypass time was 153±47 minutes, and total duration of surgery was 200±44 minutes. Mitral valve repair techniques consisted of ring annuloplasty and a variety of other methods (not mutually exclusive): "loop" neochordae (72% of patients), posterior mitral leaflet resection (28%), Alfieri stitch (17%), commissural plication (9%), chordal transfer (9%), and anterior mitral leaflet resection (7%). Concomitant procedures consisted of cryoablation for atrial fibrillation (28%), tricuspid valve repair (6%), and closure of an atrial septal defect/patent foramen ovale (12%). Thirty-day mortality was 1.4% (n=2), rethoracotomy for bleeding was required in 4.1% of patients (n=6), and conversion to sternotomy was required in 1 patient (0.7%). Long-term clinical follow-up was obtained in 100% of patients, and long-term echocardiographic data were obtained in 93.3% of surviving patients. Long-term survival was 94.7%±2.2% at 5 years and 88.3%±4.9% at 10 years. Freedom from mitral valve reoperation was 96.8%±1.6% at 5 years and 93.8%±2.6% at 10 years. Freedom from greater than 2+ grade mitral regurgitation was 90.2%±3.4% at 5 years and 88.4%±3.9% at 10 years. A wide variety of repair techniques can be used to perform successful minimally invasive mitral valve repair in the majority of patients with Barlow's disease, with good early and long-term results.