ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2024 Mar 20

DOI: 10.23736/S0021-9509.24.12899-6

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Non-resectional cordal repair for Barlow mitral valve disease

Isabella S. FLORISSI ¹ ✉, Matthew ACTON ¹, Irina KOLESNIK ², Chetan PASRIJA ³, Ishani PATEL ¹, Eric ETCHILL ¹, Sari D. HOLMES ³, Rachael QUINN ³, James S. GAMMIE ³

¹ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; ² Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; ³ Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

BACKGROUND: The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair.
METHODS: Patients included in this analysis underwent mitral valve repair from 01/2004-11/2021 by a single surgeon.
RESULTS: Of 2798 patients undergoing mitral valve operations, 46% (N.=1292) had degenerative pathology and 7% (N.=184) had Barlow disease. Of the 179 Barlow patients, median age at surgery was 62 (51-70) years; 64% were male (115/179). Rates of non-resectional cordal repair and resectional repair were 86% (154/179) and 14% (25/179). Among patients undergoing non-resectional repair, the median number of cordal pairs inserted on the anterior and posterior leaflets was 2 (2-3) and 4 (3-4). Incidence of return to bypass for systolic anterior motion of the mitral valve, perioperative death, stroke, and renal failure was 2% (4/179), 1% (2/179), 0% (0/179), and 0% (0/179). Rates of clinical and echocardiographic follow-up were 93% (165/177) and 89% (157/177). Median time to latest postoperative clinical and echocardiographic follow-up was 2.4 (0.8-6.1) and 2.1 (0.6-4.7) years. Mitral regurgitation grade at latest follow-up or time of repair failure was none/trace, mild, mild to moderate, and severe in 63% (98/157), 26% (41/157), 8% (12/157), and 4% (6/157); five of six patients with severe MR underwent reoperation. Since 2011 97% (139/144) of patients underwent cordal repair without resection.
CONCLUSIONS: Non-resectional artificial cordal repair is safe and feasible in almost all patients with Barlow valves and is associated with excellent mid-term results.

KEY WORDS: Barlow Syndrome; Mitral valve; Vascular surgical procedures