The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique

Objectives: Mitral-valve repair in Barlow's disease is challenging; convent ional techniques are difficult to perform, and there is a high risk of a po stoperative suboptimal result. Double-orifice repair has been applied in a standardized approach to treat patients with severe mitral regurgitation an d bileaflet prolapse due to Barlow's disease. Methods: Since 1993. 82 patie nts with severe mitral regurgitation due to Barlow's disease underwent corr ection applying the edge-to-edge concept. They were submitted to double-ori fice repair in a standardized fashion, suturing the middle portions of both leaflets. Results: There were no hospital deaths. The repair was unsatisfa ctory in one patient who underwent valve replacement soon after the repair. The mean postoperative valve area was 3.7 +/- 0.79 cm(2) against a mean pr eoperative value of 9.2 +/- 2.1 cm(2). No or mild regurgitation was found i n all but three patients who showed moderate residual regurgitation. There were no late deaths. Freedom from reoperation was 86 +/- 14% at 5 years. At the latest follow-up, all patient but one were New York Heart Association (NYHA) functional class I, and echo-Doppler assessment of valve reconstruct ion showed stable valve function in all patients. Conclusions: The double-o rifice repair can be used as a standardized approach to treat valve regurgi tation due to Barlow disease with low risk and good early and mid-term resu lts. (C) 2000 Elsevier Science B.V. All rights reserved.