Functional Prolapse in Barlow's Syndrome: Endoscopic Mitral Valve Repair

Objectives: Mitral valve repair is the gold standard for mitral valve regurgitation. A Barlow valve is considered difficult to repair due to complex pathology. A simple repair strategy is feasible in a subgroup of patients presenting with a functional prolapse due to a left ventricular wall motion abnormality and paradox movement of papillary muscles, together with a disjunction of the mitral valve annulus.

Methods: From 2015 to 9/2020, endoscopic repair was performed in 376 patients at our center. We identified 28 Barlow's syndrome patients (18 females, 10 males) with a functional prolapse. Totally endoscopic procedure was performed in our routine fashion using a 3D video system. The repair strategy consisted of implantation of a large annuloplasty ring together with height reduction of the posterior leaflet. The prolapsing anterior leaflet was not treated at all.

Result: Mean age was typically rather young (55 years). Repair was feasible in all patients, no conversion to sternotomy was necessary. Perioperative mortality and morbidity were 0%. The repair result was perfect with no or only trace of regurgitation at discharge. Follow-up after 24 months (mean) revealed stable repair results with 100% success rate.

Conclusion: Barlow's syndrome patients with a functional prolapse can be treated successfully with a simple repair strategy. The results of this technique are promising according to the literature and support our own excellent early and midterm outcomes in endoscopically treated patients.

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Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021