Minimally invasive mitral valve repair in patients with severe myxomatous valve degeneration (M. Barlow) is feasible and safe

Objective: Severe myxomatous mitral valve disease (M. Barlow) is frequently seen in patients with degenerative mitral valve disease, often associated with bileaflet prolapse. Repair of Barlow valves affords multiple techniques including artificial chordae. While minimally invasive mitral valve repair (MIS MVR) is meanwhile established as a routine procedure for non-myxomatous degenerative mitral valve disease it is controversely discussed if it is also safe and feasible in patients with Barlow's disease. Here we report about a series of Barlow patients who underwent MIS MVR through small lateral mini-thoracotomies under videoscopic vision at our center.

Methods: Between 2005 and 2011 67 patients underwent minimally invasive mitral valve repair for severe myxomatous degeneration (M. Barlow) and severe regurgitation (74% bileaflet prolapse). Mean patient age was 49±12.3 years. Intraoperative TEE and post-operative TTE examinations were performed for assessment of valve function.

Results: MIS MVR through anterolateral mini-thoracotomy could successfully be performed in 66 patients (98.5%), one patient underwent mitral valve replacement due to excessive valve calcification (1.5%). Cannulation of the right-sided femoral vessels for extra-corporeal circulation and transthoracic cross-clamping of the aorta was performed. In the majority of patients triangular resection of the prolapsing PML segments was followed by annuloplasty (CE Physio ring 17.9%, Myxoring 22.4%, CE Physio II ring 58.2%), artificial Goretex chordae were placed in 76.1% of patients. Additional techniques included sliding plasty, cleft closure, commissural edge-to-edge plasty and others. Three patients underwent concomitant tricuspid valve repair and 11 patients concomitant ablation therapy. Intraoperative TEE and pre-discharge TTE revealed good mitral valve function with no (n=49, 73.1%) or minimal (n=18, 26.8%) mitral regurgitation. Postoperative course was uneventful in 94.0% of patients (wound healing disorders in 3 pat., PCI of the circumflex artery for stenosis caused by a ring suture in 1 pat.). In hospital mortality was 0%.

Conclusion: MIS MVR is safe and feasible in patients with Barlow's disease. Anterolateral minithoracotomy allowed for precise placement and length measurements of artificial chords. Valve evaluation was even facilitated in comparison to sternotomy due to to a more natural view on the valve. There was no limitation in techniques for repair.