Technical aspects of mitral valve repair in Barlow’s valve with prolapse of both leaflets: triangular resection for excess tissue, sophisticated chordal replacement, and their combination (the restoration technique)

Miura, Takashi; Ariyoshi, Tsuneo; Tanigawa, Kazuyoshi; Matsukuma, Seiji; Yokose, Shogo; Sumi, Misa; Hisatomi, Kazuki; Tsuneto, Akira; Hashizume, Koji; Eishi, Kiyoyuki

doi:10.1007/s11748-014-0492-9

Cited by 13 publications

(7 citation statements)

References 26 publications

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“…Another important observation of this meta-analysis was that overall surgical volume (ie, number of patients) did not appear to influence early or late surgical outcomes. Comparing six low-volume studies (arbitrarily defined as fewer than 50 cases; one minimally invasive, 23 four sterntomy 7,8,13,19,20 ) with the rest of the cohort, there was no apparent effect of volume on the primary outcome in the meta-regression analysis.…”

Section: Random Effects Modelmentioning

confidence: 96%

“…Of 1122 articles that were retrieved for evaluation, 18 met the inclusion criteria, including one randomized controlled trial, one propensity score matching study, 11 single-arm sternotomy studies, and five single-arm minimally invasive studies (Supplemental Figure 1). 7,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] There was 100% concordance between reviewers equating to a Cohen's k of 1. The mean sample size was 92.5 patients (range, 12 to 250) and the mean follow-up duration was 51.6 months (range, 14 to 138).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Moscarelli

Fattouch

Gaudino

et al. 2020

The Annals of Thoracic Surgery

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Background. There is high demand for minimally invasive mitral valve repair; however, it is unclear whether the minimally invasive approach provides the same performance as conventional sternotomy in a context of complex mitral valve disease. Here, we compared outcomes of minimally invasive and sternotomy procedures for bileaflet and Barlow's mitral valve disease.Methods. We performed a pooled meta-analysis of studies reporting early and late follow-up of mitral valve repair for complex mitral valve regurgitation. The primary outcome was moderate mitral valve regurgitation recurrence and need for reoperation. Secondary outcomes included operation time, reopening for bleeding, associated tricuspid procedures, failed repair, and inhospital mortality. Incidence rates were calculated for long-term follow-up. Effect estimates were calculated as incidence rates with 95% confidence intervals. When Kaplan-Meier curves were available, event rates were estimated from the curves with Plot Digitizer software;

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Section: Random Effects Modelmentioning

confidence: 96%

Section: Study Characteristicsmentioning

confidence: 99%

Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Moscarelli

Fattouch

Gaudino

et al. 2020

The Annals of Thoracic Surgery

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“…Some reports have suggested a relationship between BD and mitral annular disjunction, and Hiemstra et al [ 6 ] reported annular remodeling and stabilization as being important for the surgical treatment in BD in order to correct the dilation and abnormal annulus movement. Miura et al [ 7 ] reported a restoration technique that involved reducing the lateral volume of excess leaflets in the rough zone and correcting the prolapse using a few artificial chordae. Therefore, we followed the MVr strategy according to these concepts of fixing the MV by annuloplasty, reducing excess volume by resection, and correcting the prolapse with artificial chordae, and we controlled MR without causing residual MR, MS, or SAM.…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Repair for Barlow's Disease with Mitral Annular and Subvalvular Calcification: A Case Report

et al. 2022

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Barlow's disease with mitral annular calcification encompassing the subvalvular apparatus, including the valve leaflet and chordae, is extremely rare, and mitral valve repair in such cases is challenging. We report a case of a 60-year-old woman with mitral valve regurgitation that was successfully controlled by resecting the rough zone of P2 and calcifications on the excess leaflet regions and subvalvular apparatus, while retaining the calcification of P3 and implanting artificial chordae and an annuloplasty ring. Mitral valve repair for such cases requires an individualized and compounded surgical strategy for the technique to treat Barlow's disease and manage calcification to control mitral regurgitation.

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“…It is important not to try to resect all segments which appear prolapsed because the Barlow's valve often lacks the normal reference and therefore contains the risk of excessive resection. The main purpose of the leaflet resection is to optimize the leaflet volume and restore the symmetrical shape rather than eliminate all the prolapsed segments 8 . Therefore, additional neochord implantation is sometimes necessary to correct the residual prolapse or to correct the position of the PML, which often deviates anteriorly and may promote SAM.…”

Section: Discussionmentioning

confidence: 99%

Stepwise mitral valve repair for Barlow's disease via a minimally invasive approach

Sakaguchi

Totsugawa²,

Hayashida

et al. 2020

J Card Surg

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Background and Aim Mitral regurgitation (MR) in Barlow's disease is complicated because of its mixed pathophysiology, leaflet billowing with or without organic prolapse, and abnormal annular dynamics that cause functional prolapse. Complex repair techniques, including aggressive leaflet resection and implantation of multiple artificial chordae, are conventionally performed; nevertheless, these are technically demanding, especially when performed using a minimally invasive approach. We aimed to standardize the repair technique for Barlow's disease and developed stepwise repair techniques. Methods Of 292 patients who underwent isolated minimally invasive mitral valve repair for MR, 29 patients (seven females, age 49 ± 10 years) were found to have Barlow's disease. Our repair technique consists of the following three steps: (a) stabilization of the mitral annulus by placing annuloplasty ring sutures; (b) distinction between organic and functional prolapse by a saline injection test; and (c) targeted repair for organic prolapse by leaflet resection or chordal replacement. Results Surgical techniques included leaflet resection in 22 patients, chordal replacement in 19 patients, and ring annuloplasty only in one patient. These procedures were applied to the anterior leaflet in one, posterior leaflet in eight, and both leaflets in 19 patients. The median annuloplasty ring size was 34 mm. The repair success rate was 100%. No patients developed moderate or greater MR during a mean follow‐up period of 36 ± 21 months. Conclusions A stepwise repair strategy facilitates mitral valve repair in patients with Barlow's disease and provides excellent outcomes even via a minimally invasive approach.

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Technical aspects of mitral valve repair in Barlow’s valve with prolapse of both leaflets: triangular resection for excess tissue, sophisticated chordal replacement, and their combination (the restoration technique)

Abstract: Initial experience with the restoration technique has provided excellent results without significant systolic anterior motion. Our technique may contribute to improve late results in Barlow's valve.

Cited by 13 publications

References 26 publications

Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Mitral Valve Repair for Barlow's Disease with Mitral Annular and Subvalvular Calcification: A Case Report

Stepwise mitral valve repair for Barlow's disease via a minimally invasive approach

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