Minimally Invasive Repair of Bileaflet Mitral Valve Prolapse

Objectives: Repair of bileaflet mitral valve prolapse is challenging but provides better long-term survival and clinical outcomes than replacement. We report our results with repair of Barlow's disease (significant prolapse of both leaflets with excessive tissue plus atrial displacement of the posterior annulus).

Methods: From September 2010 through December 2016, fifty-three patients from our mitral valve database were identified with Barlow's disease. We report perioperative outcome from perioperative care and follow up. Mitral valve repair was the aim in all patients and repair strategy consisted of annuloplasty (all patients), neochordae and/or leaflet resection. There was no edge-to-edge repair.

Results: Patient population (n = 53) could be characterized as followed: mean age 56 ± 12.8 years, male: 41 (77.4%), left ventricular ejection fraction: 61 ± 10.1% and a STS score of 0.9 ± 1.9. One-fifth of patients were asymptomatic. Repair was successful in all patients. Additional procedures consisted of tricuspid valve repair in 14 (26.4%), PFO closure in 39 (73.5%), cryo ablation in 11 (20.8%) and left atrial appendage closure in 11 (20.8%) patients. Procedural duration (skin-to-skin) and cross-clamp times were 180 ± 39 minute and 75 ± 22 minute, respectively. There were no intraoperative complications, no conversions to sternotomy or need for mitral valve replacement. Two patients (3.8%) died during follow up (mean 864 days; 17–2,338 days) due to non-cardiac reasons. One patient required re-repair due to ring dehiscence on postop day 25. Echocardiographic follow up showed excellent results in all patients with maximally mild regurgitation.

Conclusion: Minimally invasive mitral valve repair for Barlow's disease can safely be performed with high success rates.