Late Outcomes with Ring-only Mitral Valve Repair for Barlow Disease and Bileaflet Prolapse

Objective: Repair of degenerative severe mitral valve (MV) regurgitation in patients with Barlow disease or just bileaflet pathology is a challenging; it requires complex repair techniques and may results with higher rates of recurrent MR and higher need for re-operation. We have investigated long-term outcomes with ring only repair approach.

Methods: Between 2004 and 2018, 948 patients underwent MV repair for degenerative MR in our Medical Center. Of them, 92 had bileaflet prolapse and/or Barlow disease (age 54±16 years; 45% (n=41) male; 64% (n=59) with Barlow disease) and underwent ring-only repair. Surgical technique included only the implantation of a mitral close or open annuloplasty ring. Early and late outcome results were compared with those of the remaining 856 patients who underwent mitral valve repair for degenerative disease with posterior or anterior prolapsed flail leaflet (controls). Clinical and echocardiographic follow-up was complete for all patients.

Results: In-hospital mortality (0% vs. 0.3%), stroke rate (1% vs. 2%), and renal failure (4% vs. 3%) were comparable between the groups, while the incidence of atrial fibrillation was lower in the ring-only group (12% vs. 22%, p=0.03). At follow-up, there were 6 (8%) late deaths in the ring-only group compared with 60 (7%) (p=1.000) in the controls, and 3 (3%) reoperations compared with 66 (8%) (p=0.140) in the controls (Figure). Late follow-up revealed New York Heart Association functional class I or II in 90% (n=83) of the ring-only patients, compared with 92% (n=785) in the controls. Freedom from recurrent moderate or severe MR was 92% (n=84) and 84% (n=716) at 47±43 months in the ring-only and control groups, respectively (p=0.165).

Conclusions: MV repair by annuloplasty ring-only technique for degenerative Barlow or Bileaflet disease and a dominant central regurgitant jet is both simple and provides excellent late clinical and echocardiographic outcomes.