Functional Prolapse in Barlow Syndrome: Endoscopic Mitral Valve Repair
Daniel Hoefer, Nikos Bonaros, Michael Grimm, Ludwig Mueller
Cardiac Surgery Innsbruck, Innsbruck, Austria
BACKGROUND: 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 12/2020 endoscopic repair was performed in 405 patients at our center. We identified 33 Barlow´s syndrome patients (17 female, 16 male) with a functional prolapse. Totally endoscopic procedure was carried out 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.
RESULTS: 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 24months (mean) revealed stable repair results with 100% success rate.
CONCLUSIONS: 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 mid-term outcomes in endoscopically treated patients.