title: The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique.
abstract: OBJECTIVE
  Mitral-valve repair in Barlow's disease is challenging; conventional techniques are difficult to perform, and there is a high risk of a postoperative suboptimal result. Double-orifice repair has been applied in a standardized approach to treat patients with severe mitral regurgitation and bileaflet prolapse due to Barlow's disease.
  
  
  METHODS
  Since 1993, 82 patients with severe mitral regurgitation due to Barlow's disease underwent correction applying the edge-to-edge concept. They were submitted to double-orifice repair in a standardized fashion, suturing the middle portions of both leaflets.
  
  
  RESULTS
  There were no hospital deaths. The repair was unsatisfactory in one patient who underwent valve replacement soon after the repair. The mean postoperative valve area was 3.7+/-0.79 cm(2) against a mean preoperative value of 9.2+/-2.1 cm(2). No or mild regurgitation was found in all but three patients who showed moderate residual regurgitation. There were no late deaths. Freedom from reoperation was 86+/-14% at 5 years. At the latest follow-up, all patient but one were New York Heart Association (NYHA) functional class I, and echo-Doppler assessment of valve reconstruction showed stable valve function in all patients.
  
  
  CONCLUSIONS
  The double-orifice repair can be used as a standardized approach to treat valve regurgitation due to Barlow disease with low risk and good early and mid-term results.
authors.affiliation: Cardiac Surgery Department, IRRCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy. francesco.maisano@hsr.it
authors.forename: F
authors.initials: F
authors.lastname: Maisano
authors.forename: J J
authors.initials: JJ
authors.lastname: Schreuder
authors.forename: M
authors.initials: M
authors.lastname: Oppizzi
authors.forename: B
authors.initials: B
authors.lastname: Fiorani
authors.forename: C
authors.initials: C
authors.lastname: Fino
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000150:complications*; D013536:Suture Techniques