Mitral valve repair for Barlow disease – long-term results

Objective: Barlow disease is a still challenging pathology for heart surgeons. Aim of the present study is to report 5-year follow-up results of mitral valve repair in Barlow disease from a single large volume center. Methods: Between January 1st, 2008 and December 31st, 2011, 85 consecutive patients (54 men and 31 women) underwent mitral repair of Barlow mitral valve disease Mean age was 59 ±14 years (range: 28-85 years). Before surgery 47% of patients were in NYHA functional class III or IV. Reconstructive techniques were posterior leaflet quadrangular resection with (50.6%) or without (37.8%) leaflet sliding plasty, implantation of Gore-Tex artificial chordae (53.0%), and mitral annuloplasty, that was performed in all patients. Concomitant procedures included tricuspid valve repair, aortic valve repair or replacement, coronary artery bypass graft surgery, and modified maize procedure. Results: There were no perioperative in-hospital deaths. Intraoperative TEE did not disclose any early failure of valve repair. Postoperative minor complications were detected in 19 patients. Two patients died during follow-up. At five-year follow-up in the 83 surviving patients NYHA functional class improved significantly (p<0,0001). Significant postoperative atrial and ventricular remodeling occurred after surgery. 48 (57.8%) patients had no residual regurgitation and 24 (28.9%) showed trivial or mild mitral regurgitation. Mild to moderate regurgitation was found in 10 (12%), only one developed severe mitral regurgitation. Chordal elongation and anterior leaflet flail were related to recurrence of mitral regurgitation. Conclusion: Repair of the mitral valve is currently the surgical treatment of choice for complex degenerative mitral valve disease and should be pursued even in the most advanced forms of Barlow disease. Careful selection of patients, early surgical intervention, optimization of surgical techniques including use of large size annuloplasty rings and artificial chordae, along with surgical expertise in mitral valve repair are the main determinants to decrease the risk of recurrent mitral regurgitation although progression of disease may be responsible for most of reinterventions.