Mid- to long-term results of minimally invasive repair of Barlow’s disease with posterior leaflet resection and chordal transfer

OBJECTIVE: Mitral valve repair (MVr) in Barlow's disease (BD) is technically demanding, requires complex repair techniques. Following a previous report including posterior mitral leaflet (PML) resection and chordal transfer plus annuloplasty applicable via minimally invasive approach, herein we present mid to long term results of patients undergoing MVr for BD with this defined repair approach. METHODS: Between September 2009 and February 2021, 55 patients underwent minimally invasive MVr for BD with severe mitral regurgitation (MR), containing resection of P2-segment of PML and transfer of preserved P2-chordae to A2 with implantation of a semi-rigid open ring. Mid to long term follow-up clinical data and recent transthoracic echocardiography (TTE) results were analyzed. RESULTS: The initial successful repair rate was 98.2% (n = 54). 30-days mortality was 0%. Follow-up was completed in 50 patients (90.9%) with a mean of 60.2 ± 37.6 months (range; 2-127 months), while 5 patients were lost to follow-up. For patients who underwent MVr at the time of primary surgery (i.e., excluding one patient with MV replacement), the mid- to long-term survival rate after successful MVr was 92.8% at 5 years and 88.2% at 8 years. The freedom from reoperation rate and the freedom from MR ≧ grade 2 was 97.3% at 5 years and 81.3% at 8 years. There was no systolic anterior motion at follow-up. CONCLUSIONS: This minimally invasive repair approach combining posterior leaflet resection and chordal transfer demonstrated a high repair rate and favorable mid- to long-term outcomes in patients with BD when performed in an experienced center.