Abstract 16512: Nonresectional Surgical Technique Repair of Mitral Valve Insufficiency from Barlow's Valve Disease
Introduction: Barlow’s disease is the severest form of myxomatous degeneration (MD) of the mitral valve. Some consider it not repairable; others regard leaflet resection as vital to avoid SAM. We define Barlow’s disease as marked enlargement, redundancy and severe prolapse of all segments of both leaflets. More severe localized segmental prolapse also may be present. Hypothesis: We assessed the hypothesis that surgical repair of Barlow’s disease can be done without leaflet resection if the normal mechanisms which displace the anterior mitral leaflet out of the LVOT during systole are preserved. Leaflet preservation should lead to higher repair rates.
Methods: From 1997 through 2011, 103 Barlow’s patients (B) underwent repair. The technique was dynamic intraoperative simulation of mitral annular, left ventricular and papillary muscle position by inflation to LV systolic pressure to allow accurate restoration of subannular leaflet apposition with a flexible full ring annuloplasty. Localized leaflet edge malalignment was treated with PTFE chordae. We compared these pts with 491 pts who had repair for leaflet prolapse due to non-Barlow’s (MD) (NB). Gender, preop MR and preop EF were similar (p=NS). CAD was lower in B, 5.8% (6/103) than in NB 18.2% (89/489) p=0.0031; B had more Afib, 63% (34/54) than NB, 42% (136/327) p=0.0054. B pts were younger (56.24±12.87) than NB pts (60.67±13.89 p=0.0030.
Results: B reparability was (100%). Freedom from reoperation at 10 yrs by Kaplan-Meier (KM) was 94.8% for NB pts and 94.9% for B pts, p=NS. Freedom from significant late MR (echo) at 10 yrs by KM was 85% for NB pts; 96% for B pts, p=NS. Survival at 10 yrs by KM for NB pts was 66.1%; for B pts was 95.6%, p=0.0151. Relative risk by Cox analysis identified older age, concomitant AVR, increased MR as risks to survival; increasing EF and decreasing age as risks for reoperation.
Conclusion: Preop size of the mitral annulus and papillary muscle traction are the main determinants of the extent of symmetrical leaflet prolapse and leaflet apposition. Restoration of these parameters to proper dimensions markedly reduces leaflet billowing and leaflet systolic stress. Correctly sized flexible ring annuloplasty without leaflet resection produces good results and does not cause SAM.
- © 2012 by American Heart Association, Inc.