Simple technique of repair for Barlow syndrome with posterior resection and chordal transfer via minimally invasive approach: primary experience in a consecutive series of 22 patients.
OBJECTIVE
Current techniques for mitral valve repair (MVR) in Barlow's disease require high level of surgical expertise due to a complex anatomy. A novel and simple standardized technique that particularly considers the pathological changes of the mitral valve in Barlow's disease has been developed.


METHODS
Between 2009 and 2013, 22 patients underwent minimally invasive MVR for Barlow's disease and severe mitral regurgitation (MR). A simple, standardized technique was applied, including resection of P2 segment of posterior mitral leaflet (PML) with preservation of the shortest chordae, transfer of the preserved chordae to A2, and implantation of a semi-rigid open ring. In 2015, all patients were contacted for follow-up by transthoracic echocardiography (TTE) and interviewed for their clinical status.


RESULTS
During follow-up (mean 2.8 ± 1.1 years; 100% complete), one patient died due to abdominal bleeding 4 months after the initial MVR and one patient with severe calcification of PML underwent valve replacement due to recurrence of MR. Among the remaining cohort (mean follow-up 3.0 ± 1.0 years), NYHA class I, II and III was present in 13, 6, and 1, respectively. TTE demonstrated MR grade 0, 1+, or 2+ in 40, 55, and 5%, respectively, with mean and maximum transvalvular gradients ranging at 1.9 ± 1.7 and 4.7 ± 3.3 mmHg, respectively.


CONCLUSIONS
A simple and standardized technique facilitates the repair of MR in the presence of Barlow's, simultaneously addressing the height of PML and the position of the anterior leaflet. This technique has proven durable in the mid-term follow-up in our small series and warrants further validation in larger cohorts.
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.|Department of Cardiac Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
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Kamiya
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany. payam.akhyari@med.uni-duesseldorf.de.
Payam
http://orcid.org/0000-0002-6452-8678
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Akhyari
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Minol
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Ites
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Weinreich
Department of Anesthesiology, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Sixt
Department of Anesthesiology, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Rellecke
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Boeken
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Albert
Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Lichtenberg
D006348:Cardiac Surgical Procedures / Q000379:methods*; D002815:Chordae Tendineae / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
Barlow; Minimally invasive cardiac surgery; Mitral valve; Myxomateous disease; Surgical repair