A Standardized Technique of Repair of the Mitral Valve in Barlow Disease: Results in a Series of 41 Consecutive Patients

Objectives: Repair of the mitral valve (MV repair) for myxomatous degeneration (Barlow’s disease) remains a surgical challenge requiring a high level of surgical expertise. Here, a standardized technique addressing the key pathological changes of the mitral valve in Barlow’s disease is proposed. In-hospital and 1-year follow-up-results are presented.

Methods: Between September 2009 and August 2018, forty-one patients underwent minimally invasive MV repair for Barlow’s disease and severe mitral regurgitation (MR) with resection of P2-segment of the posterior mitral leaflet (PML) and transfer of preserved P2-chordae to A2 with implantation of a semirigid open ring. Procedural and discharge data as well as follow-up data at 1 year including transthoracic echocardiography (TTE) results and clinical status were analyzed.

Results: Bypass and aortic cross-clamp times were 185 ± 54 and 119 ± 35 min. Duration of postoperative stay on intensive and intermediate care wards were 2.1 ± 4 and 2.9 ± 3.9 days, respectively. At 1-year follow-up (100% complete), two patients had died, one due to abdominal bleeding 4 months after initial MV repair and one patient after reoperation for endocarditis. One patient with severe calcification of PML underwent valve replacement due to recurrence of MR. Among the remaining cohort with minimum follow-up of 1 year (n = 31) NYHA classes I and II were present in 74 and 26% of patients, respectively. TTE demonstrated MR grade 0, 1, or 2 in 79, 18, and 3% at discharge and in 55, 42, and 3% at 1 year, respectively.

Conclusions: Standardization of the surgical technique facilitates the MV repair in Barlow’s disease, addressing the height of both leaflets and providing high repair rate and stable results at follow-up after the first year.