A balanced mitral leaflet and large ring strategy avoids systolic anterior motion in Barlow's disease

Mitral valve repair for Barlow's disease offers good outcomes but excessive and myxomatous valvular tissue is associated with systolic anterior motion. Although valvular disease might progress after repair and cause long-term systolic anterior motion, few reports focus on this aspect. Herein, we will review our 16-year experience with mitral valve repair for Barlow's disease and systolic anterior motion incidence.

We retrospectively reviewed surgical outcomes of 92 cases of mitral valve repair using a balanced leaflet/large ring strategy plus median sternotomy for Barlow's disease (median age 45.1 ± 12.7 years old [19-72], 37 females) from 2004 to 2019. Concomitant surgeries, except for tricuspid valve or anti-arrhythmic surgeries, were excluded.

The follow-up period was 5.8 ± 4.4 years with no deaths. Patients had mitral regurgitation of grade 3/4 (15 cases) or 4/4 (77 cases) due to anterior leaflet (3 cases), posterior leaflet (75 cases), or bileaflet (14 cases) prolapse, with chord elongation (39 cases), chord rupture (22 cases), or a combination of both (14 cases). All cases required ring annuloplasty (median size of 33.0 ± 5.4 mm) combined with leaflet resection (91 cases), chord intervention (12 cases), or indentation closure (2 cases). No case had short- or long-term SAM. The freedom-from-mitral-regurgitation (of greater than grade 2/4) rate was 94.1% over 5 years and 76.0% over 10 years without reoperation.

Our two-pronged strategy for mitral valve repair in Barlow's disease avoids systolic anterior motion over the long-term, with good outcomes.