The no-resection-technique for mitral valve repair in Barlow disease

Objectives: The resection technique for the repair of structural mitral valve pathology is common. However, new techniques recently performed follow the “Respect rather than Resect” approach. Our mitral valve repair technique aims at avoiding any resection of valve tissue in almost any pathology including complex cases of M. Barlow using artificial chordae as a universal solution. The idea is to achieve the highest possible coaptation area and preserve a normal leaflet motion to reach a repair for life.

Methods: Between 2005 and 2013, 111 patients with Morbus Barlow underwent mitral valve surgery. Mean age was 58.9 ± 12.2 years, EF was 48 ± 8.5, 63% were male, 3 patients had atrial fibrillation, systolic PAP was elevated (>40 mmHG) in 20 pts.. Concomitant procedures were CABG (2.9%), closure of ASD / PFO (4.9%) and tricuspid anuloplasty (2.9%). Repair rate was 100%. The No-Resection repair technique was performed in all patients with artificial chordae and with closure of the indentations in the posterior leaflet. In addition, large (>34 mm) anuloplasty rings (n = 31) or bands (n = 80) were used.

Results: There was no operative mortality. One patient had severe bleeding and resuscitation. Minor complications included rethoracotomy for bleeding (3 pts.) and reintubation (2 pts.). There were no complications concerning the mitral valve (mitral valve replacement or any reintervention). Mean CCT and CPB times were 56 ± 9 min and 73 ± 10 min, respectively. Postoperative TEE and TTE at discharge showed no or trivial mitral regurgitation in all patients and a mean coaptation area of ≥1,1 cm in all without any signs of SAM. Follow up at 4,2 ± 2,1 years (up to 7 years) (90% follow-up, no mortality) demonstrated a stable repair without changes in the echocardiographic parameters.

Conclusion: The No-Resection approach with artificial chordae and large anuloplasty devices is feasible for mitral valve repair in M. Barlow. The resulting large coaptation area without SAM leads to excellent operative and mid-term results and expected long term durability.