loading page

Minimally Invasive Valve Repair in Bi-Leaflets Prolapse Mitral Regurgitation (Barlow’s Disease)
  • +8
  • Alessandro Barbone,
  • Alessio Basciu,
  • Alessandra Iaccarino,
  • Ginevra Droandi,
  • Giorgio Romano,
  • Ines Andriani,
  • Mauro Chiarito,
  • Andrea Fumero,
  • Enrico Citterio,
  • Giuseppe Crescenzi,
  • Lucia Torracca
Alessandro Barbone
IRCCS Humanitas Clinical and Research Center

Corresponding Author:[email protected]

Author Profile
Alessio Basciu
IRCCS Humanitas Clinical and Research Center
Author Profile
Alessandra Iaccarino
IRCCS Humanitas Clinical and Research Center
Author Profile
Ginevra Droandi
IRCCS Humanitas Clinical and Research Center
Author Profile
Giorgio Romano
IRCCS Humanitas Clinical and Research Center
Author Profile
Ines Andriani
IRCCS Humanitas Clinical and Research Center
Author Profile
Mauro Chiarito
Humanitas University
Author Profile
Andrea Fumero
IRCCS Humanitas Clinical and Research Center
Author Profile
Enrico Citterio
IRCCS Humanitas Clinical and Research Center
Author Profile
Giuseppe Crescenzi
IRCCS Humanitas Clinical and Research Center
Author Profile
Lucia Torracca
IRCCS Humanitas Clinical and Research Center
Author Profile

Abstract

Background and Aim of the Study: Barlow’s disease is characterized by excess myxomatous degenerative tissue, leaflets prolapse and/or billowing, chordal-elongation, and annular-dilation. We reviewed our experience in Minimally Invasive Mitral Valve Repair (MIMVR) techniques to treat this complex mitral pathology. Methods: Between 1999 and 2017 a group of 125 patients was identified as Barlow’s disease undergoing MIMVR. The diagnosis of Barlow disease was based upon preoperative transesophageal-echocardiography (TEE) and confirmed by the surgeon’s assessment during open-heart procedure. Operative technique and data were retrospectively collected along with intra-hospital and long-term follow-up. Results: Successful Mitral Repair was possible in 100% of cases (125 patents) within the first cross clamp. Most patients (118 – 94.4%) were treated by the Edge to Edge (Alfieri-Stich), while 2 (1.6%) where corrected by neochordae implant and 2 (1.6%) by quadrangular resection. 58 patients (47.1%) received complete semi-rigid ring, while 65 (52.9%) incomplete flexible partial ring excluding the LAM. Concomitant procedures were additional cleft occlusion in 10 cases (8%), tricuspid valve repair (ring implant or remodeling) in 29 cases (23.2%), left atrial ablation for atrial fibrillation in 4 cases (3.2%) and atrial septal repair in 4 (3.2%). Operative mortality was 0%. Average long-term follow-up was 85 ± 62 months, with a survival rate of 97.6%, freedom from redo mitral surgery of 98.4% and freedom from >2+ recurrent mitral regurgitation of 94.5%. No difference in outcome could be related to annuloplasty ring type. Conclusions: Mitral repair can be safely and successfully achieved though minimal-invasive approach, with optimal long-term results.