TY - JOUR
T1 - Mitral valve repair in Barlow's disease with bileaflet prolapse: The effect of annular stabilization on functional mitral valve leaflet prolapse
AU - Tomšič, Anton
AU - Hiemstra, Yasmine L.
AU - Bissessar, Daniella D.
AU - van Brakel, Thomas J.
AU - Versteegh, Michel I. M.
AU - Ajmone Marsan, Nina
AU - Klautz, Robert J. M.
AU - Palmen, Meindert
PY - 2018
Y1 - 2018
N2 - OBJECTIVES: Barlow's disease is the most severe form of degenerative mitral valve disease, commonly characterized by bileaflet prolapse. Abnormal mitral annular dynamics is typically present and results in functional prolapse of the mitral leaflets that may be addressed with annular stabilization alone. METHODS: Between January 2001 and December 2015, 128 patients with Barlow's disease and bileaflet prolapse underwent valve repair. This included anterior mitral valve leaflet (AMVL) repair in 70 patients, whereas 58 patients were identified as having functional prolapse and underwent no specific AMVL repair. During the course of the study, the proportion of patients undergoing specific AMVL repair decreased (77% in the first and 33% in the second 64 patients). Semirigid ring annuloplasty was performed in all cases. The median clinical and echocardiographic follow-up duration was 6.5 years [interquartile range (IQR) 2.910.5 years; 93.9% complete] and 4.7 years (IQR 2.2 10.2 years; 94.4% complete), respectively. RESULTS: Early mortality was 1.6%. Postoperative echocardiogram demonstrated no residual mitral regurgitation in all but 1 patient (AMVL repair group). There was no significant difference in the overall survival rate at 6 years after operation between both groups. At 6 years, the freedom from recurrent >-Grade 2+ mitral regurgitation rate was 90.7% (IQR 82.998.5%) and 89.1% (IQR 75.8100%) for patients with and patients with no AMVL repair, respectively (P = 0.43). Three patients required late mitral valve reintervention, all from the AMVL repair group. CONCLUSIONS: Annular stabilization can effectively resolve the functional prolapse of the AMVL. Careful discrimination between functional and true AMVL prolapse allows for a technically less challenging operation that provides excellent repair durability.
AB - OBJECTIVES: Barlow's disease is the most severe form of degenerative mitral valve disease, commonly characterized by bileaflet prolapse. Abnormal mitral annular dynamics is typically present and results in functional prolapse of the mitral leaflets that may be addressed with annular stabilization alone. METHODS: Between January 2001 and December 2015, 128 patients with Barlow's disease and bileaflet prolapse underwent valve repair. This included anterior mitral valve leaflet (AMVL) repair in 70 patients, whereas 58 patients were identified as having functional prolapse and underwent no specific AMVL repair. During the course of the study, the proportion of patients undergoing specific AMVL repair decreased (77% in the first and 33% in the second 64 patients). Semirigid ring annuloplasty was performed in all cases. The median clinical and echocardiographic follow-up duration was 6.5 years [interquartile range (IQR) 2.910.5 years; 93.9% complete] and 4.7 years (IQR 2.2 10.2 years; 94.4% complete), respectively. RESULTS: Early mortality was 1.6%. Postoperative echocardiogram demonstrated no residual mitral regurgitation in all but 1 patient (AMVL repair group). There was no significant difference in the overall survival rate at 6 years after operation between both groups. At 6 years, the freedom from recurrent >-Grade 2+ mitral regurgitation rate was 90.7% (IQR 82.998.5%) and 89.1% (IQR 75.8100%) for patients with and patients with no AMVL repair, respectively (P = 0.43). Three patients required late mitral valve reintervention, all from the AMVL repair group. CONCLUSIONS: Annular stabilization can effectively resolve the functional prolapse of the AMVL. Careful discrimination between functional and true AMVL prolapse allows for a technically less challenging operation that provides excellent repair durability.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85044768497&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29186494
U2 - https://doi.org/10.1093/icvts/ivx366
DO - https://doi.org/10.1093/icvts/ivx366
M3 - Article
C2 - 29186494
SN - 1569-9293
VL - 26
SP - 559
EP - 565
JO - Interactive cardiovascular and thoracic surgery
JF - Interactive cardiovascular and thoracic surgery
IS - 4
ER -