Key result
Endoscopic mitral valve repair for Barlow's disease matches isolated PML prolapse in 10-year durability and survival.
Why the study?
Totally endoscopic mitral valve repair is an established treatment for primary mitral regurgitation, but performing it in Barlow's disease might be challenging due to complex pathology, warranting investigation of long-term outcomes compared to repair for isolated posterior mitral leaflet prolapse.
Does totally endoscopic mitral valve repair provide similar long-term survival and freedom from re-operation in patients with Barlow's disease compared to those with isolated posterior mitral leaflet prolapse?
Cohort (n=435)
No
Does totally endoscopic mitral valve repair provide similar long-term survival and freedom from re-operation in patients with Barlow's disease compared to those with isolated posterior mitral leaflet prolapse?
Totally endoscopic mitral valve repair for Barlow's disease is safe and durable, achieving 10-year survival and freedom from re-operation rates comparable to repair for isolated posterior leaflet prolapse despite requiring more complex surgical techniques.
Answers are grounded in this paper and cite their sources.
Similar durability supports endoscopic repair in Barlow's disease; leaves open multicenter prospective validation.
Structured Abstract Objectives Totally endoscopic mitral valve repair (TE-MVR) is an established treatment for primary mitral regurgitation. However, TE-MVR in Barlow´s disease (BD) might be challenging due to its complex pathology. Herein, investigation of long-term outcomes after TE-MVR for BD is conducted and results are compared to TE-MVR for isolated posterior mitral leaflet (PML) prolapse. Methods Between 2012 and 2022, out of 1055 patients, 131 patients underwent TE-MVR due to BD (group 1) and 304 patients due to isolated PML prolapse (group 2) at our center. Baseline characteristics, surgical techniques and clinical/echocardiographic outcomes up to 10 years were retrospectively analyzed. Results BD patients were younger (group 1: 53.0±13.4 vs. group 2: 59.9±10.7 years, p<0.001) and more frequently female (46.6% vs. 31.6%, p=0.002). Cross-clamp time was longer in BD (110.8±38.3 vs. 103.1±32.2 min, p=0.046), cardiopulmonary bypass and procedure times were similar. Annuloplasty ring size was larger in BD (36.3±2.6 vs. 33.0±2.7 mm, p<0.001). Repair techniques in BD consisted of: neochordae to PML (55.0%), neochordae to AML (31.3%), leaflet resection (31.3%), Alfieri stitch (14.5%); 83.8% of PML patients received annuloplasty and neochordae to PML only. 30-day mortality was similar (0.8% vs. 0.3%, p=0.510). Ten-year survival (90.3% vs. 91.9%, p=0.879) and freedom from re-operation (95.5% vs. 97.8%, p=0.433) were similar. Conclusions TE-MVR in BD is safe and durable. Despite the need for more complex repair techniques, acute and long-term outcomes as well as durability were excellent. Durability of TE-MVR in Barlow's disease beyond 10 years of follow-up should be subject to further investigations. Abstract word count : 244
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Schaefer et al. (2026) conducted a cohort in Primary mitral regurgitation (Barlow's disease and isolated posterior mitral leaflet prolapse) (n=435). Totally endoscopic mitral valve repair for Barlow's disease vs. Totally endoscopic mitral valve repair for isolated posterior mitral leaflet prolapse was evaluated on 10-year freedom from re-operation (p=0.433). Totally endoscopic mitral valve repair for Barlow's disease achieved similar 10-year freedom from re-operation and survival as isolated PML prolapse.
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