Left ventricle reverse remodeling after barlow mitral valve repair with leaflet preservation versus leaflet resection

Tóm tắt

Background: Left ventricular (LV) remodeling is a characteristic consequence of chronic volume overload in Barlow’s disease. While mitral valve repair (MVR) is the gold standard treatment, the impact of specific surgical techniques—specifically leaflet preservation ("Respect") versus leaflet resection ("Resect")—on the subsequent process of LV reverse remodeling remains a subject of clinical debate.

Methods: We conducted a study of 68 patients with Barlow’s disease who successfully underwent minimally invasive MVR at University Medical Center between 2020 and 2025. Patients were evaluated using preoperative and postoperative echocardiography at discharge and 1-year follow-up to track LV morphological evolution and functional recovery.

Results: A significant reverse remodeling process was observed across the cohort, with LV end-diastolic diameter (LVEDD) decreasing from 58.1 ± 5.0 mm to 47.8 ± 6.2 mm at one year (p < 0.001). An initial "LVEF paradox" was noted, where mean LVEF dropped from 62.3% to 53.4% at discharge before rebounding to 57.6% at 12 months. Subgroup analysis revealed that the "Respect" technique (n=37) achieved significantly higher mean LVEF at 1-year (59.1 ± 5.4%) compared to the "Resect" technique (55.9 ± 6.2%, p = 0.018). Furthermore, 82.6% of "top performers" (LVEF > 60%) were from the Respect group. Optimized annular downsizing (7–11 mm) was also strongly correlated with superior systolic recovery.

Conclusions: Surgical repair for Barlow’s disease facilitates robust LV reverse remodeling. However, a leaflet-preservation strategy ("Respect") combined with optimized annular downsizing provides superior 1-year functional outcomes compared to leaflet resection, supporting a "Respect-first" approach to maximize hemodynamic benefits.