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Simple Repair for Mitral Regurgitation in Barlow Disease
Sagit Ben Zekry, Dan Spiegelstein, Innon Lev, Leonid Sternik, Alexander Kogan, Rafi Kuperstein, Ehud Raanani.
Sheba Medical Center, Tel Hashomer, Israel.

OBJECTIVE: Mitral valve (MV) repair for myxomatous disease with Barlow disease is challenging. Multi segment prolapse, excessive leaflets tissue and huge annulus require complex surgery with less optimal results. Thus, we present a simple technique for repair.
METHODS: Between the years 2005-2013, 560 patients with degenerative MV regurgitation underwent valve repair. Of them, seventeen patients with Barlow disease underwent Ring-only repair (age 49±14 years, 35% male). All of these patients had very large MV annulus and multi segment prolapse involving both leaflets. The unique feature in those patients was that the main regurgitant jet was central. The surgical technique included only implantation of a mitral annuloplasty ring (average ring size of 36±4 mm, 15 patients with CE Physio, 1 patient with CE Classic, 1 patient with CE Cosgrove) in order to achieve adequate leaflets coaptation and abolish the regurgitation jet.
RESULTS: All patients presented with moderate-severe/severe mitral regurgitation (vena contracta 0.6±0.1cm, regurgitation volume 52±22ml) with preserved ejection fraction (58±22%). The mitral regurgitation jet was central in 12 patients while in the rest of the patients had combined central and eccentric jet. No flail was noted. Cardiopulmonary bypass and cross-clamp times were, 68±28 and 52±19 minutes. Post- repair mean coaptation length was 16±2 mm. There was no in-hospital mortality. Hospital length of stay was 5.2±1.4 days, where the only complication seen was transient atrial fibrillation in 3 patients. Mean follow up (FU) was 38±27 months. There was no long term death as well as no need for reoperation during the follow up. Mean FU NYHA class is: 1.6±0.8.Echocardiography FU revealed that all patients are free of moderate or severe MR.
CONCLUSIONS: Mitral annuloplasty only for patients with severe multi segment myxomatous disease (Barlow), with central jet is safe, simple and reproducible with excellent mid term results. The post-operative long coaptation length may provide good long term results.

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