Minimal invasive mitral valve repair for Barlow syndrome: Early and long-term results

Objective: Barlow syndrome represents a surgical challenge for patients presenting with mitral regurgitation. We reviewed our early and long-term results for patients undergoing minimal invasive mitral valve (MV) surgery for Barlow syndrome. Methods: Our institutional database was reviewed to identify patients with Barlow syndrome operated on between 1999 and 2010. Intraoperative transesophageal echocardiography and surgical valve inspection were used to identify patients with Barlow syndrome defined as those with bileaflet prolapse, extensive leaflet billowing, excess leaflet tissue, and/or leaflet or annular calcification. Minimal invasive MV surgery was performed in all patients. All patients underwent minimal invasive MV surgery via a right mini-thoracotomy with femoral cannulation for cardiopulmonary bypass (CPB). A total of 144 patients with Barlow syndrome were identified. The average age was 51 ± 13 years and 63% of patients were male. Successful MV repair was performed in 95% of patients, initial MV replacement in 2%, and MV replacement following unsuccessful MV repair in 3%. MV repair techniques consisted of neochordae formation with the Loop technique in 72% of patients, chordal transfer in 9%, posterior mitral leaflet resection in 30%, anterior mitral leaflet resection in 7%, the Alfieri technique in 18%, and commissural plication in 9% (techniques not mutually exclusive). Concomitant procedures consisted of atrial fibrillation ablation in 28%, tricuspid valve repair in 6%, and closure of an atrial septal defect or patent foramen ovale in 10%. Long-term follow up was available in all patients. Results: Mean aortic crossclamp and CPB times were 101 ± 30 and 154 ± 39 minutes, respectively, and total duration of operation was 200 ± 42 minutes. Thirty day mortality occurred in 2 patients (1%). Rethoracotomy for bleeding was required in 8% of patients, respiratory insufficiency occurred in 6%, and any postoperative arrhythmia in 38%. Long-term survival was 91 ± 4% in all patients six years postoperatively. Freedom from MV reoperation was 95 ± 1% six years postoperatively in all patients. In those patients who underwent MV repair, freedom from MV replacement was 98 ± 1% six years postoperatively. Conclusions: Minimal invasive MV surgery using a variety of repair techniques can be used to perform successful MV repair in the majority of patients with Barlow syndrome, with very good early and long-term results.