Repair with annuloplasty only of balanced bileaflet mitral valve prolapse with severe regurgitation

Ehud Raanani, Ehud Schwammenthal, Yaron Moshkovitz, Hillit Cohen, Alexander Kogan, Yael Peled, Leonid Sternik, Eilon Ram*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Repair of severe mitral valve and mitral regurgitation (MR) in patients with degenerative bileaflet pathology can be challenging. Initial results with a ring-only repair (ROR) approach have shown promising results, but long-term outcomes in larger series are lacking. We report on outcomes of ROR in severe MR secondary to bileaflet prolapse, including Barlow's disease. METHODS: Eighty patients with degenerative multi-segment bileaflet disease underwent ROR for severe MR with a predominantly central regurgitant jet indicating balanced bileaflet prolapse. The main outcome measure of this study was long-term recurrent MR probability. Secondary outcomes were late mortality, reoperation and in-hospital complications. RESULTS: The mean age was 53 ± 15 years and 54% were males. The mean ejection fraction was 59.2 ± 6.6, 24% and 40% had atrial fibrillation. Barlow's disease was found in 77% of the patients. Minimally invasive surgery was performed in 15 patients (19%). There were no perioperative mortalities or cerebrovascular events in the entire cohort. Post-repair mild outflow tract obstruction (systolic anterior motion) was observed in 4 patients (5%) after ROR. In a mean follow-up of 60 ± 48 months, there was 1 case of death. At follow-up, there was 1 (1%) reoperation due to recurrent MR, and 4 patients who had recurrent moderate or more MR. The 10-year freedom from recurrent MR was 97%. None had severe MR at the latest follow-up. CONCLUSIONS: In patients with severe MR and a central regurgitant jet secondary to balanced multi-segment bileaflet mitral valve prolapse, ROR is a simple and efficient approach providing excellent long-term results without a substantial risk of systolic anterior motion.

Original languageEnglish
Pages (from-to)908-916
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number4
StatePublished - 1 Apr 2022


  • Annuloplasty
  • Barlow disease
  • Bileaflet prolapse
  • Mitral valve repair
  • Multi-segment prolapse
  • Ring-only repair


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