Minimally invasive mitral valve repair in the context of Barlow's disease

Background. The aim of this study is to report our overall experience with minimally invasive mitral valve repair for correction of severe mitral regurgitation in the setting of Barlow's disease. Methods. Between 1999 and 2003, 48 patients with bileaflet prolapse in the context of Barlow's disease underwent minimally invasive mitral valve repair using the "edge-to-edge" technique. Mean age was 37.9 +/- 9.1 and 58% were female. Most of the patients were in New York Heart Association (NYHA) class I or II and all of them had normal left ventricular ejection fraction. Results. There were no conversions to sternotomy. Mean cardiopulmonary bypass and aortic cross-clamp times were 77 +/- 16 minutes and 56 +/- 8 minutes. No in-hospital deaths and no major postoperative complications occurred. At a mean follow-up of 22.7 +/- 10.6 months, survival rate and freedom from reoperation were 100%. All patients were in NYHA class I and in sinus rhythm. No residual mitral regurgitation was detected at echocardiography in 33 (68.7%) patients and mild insufficiency was found in 15 (31.2%). The degree of satisfaction in terms of cosmesis and postoperative pain was very high and 73% of the patients were back to work and to normal activity in 4 weeks. Conclusions. Mitral insufficiency due to Barlow's disease can be effectively corrected through a minimally invasive approach by using the "edge-to-edge" technique. In our opinion, the excellent midterm results and the high degree of patients satisfaction certainly justify the adoption of this strategy in a selected group of young and active people. (c) 2005 by The Society of Thoracic Surgeons.