ArticleJTCVS open2026
Minimally invasive mitral valve repair: Ten-year outcomes of the "Re-Lock technique" for complex bileaflet mitral valve disease.
Article in JTCVS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: The objective was to evaluate the 10-year clinical and echocardiographic outcomes of minimally invasive Re-Lock mitral valve repair for Barlow-type or complex bileaflet degenerative disease, evaluating overall survival, freedom from mitral regurgitation 2+ or greater, need for reoperation, and New York Heart Associaton class. Methods: From 2008 to 2016, 140 consecutive patients with Barlow-type degenerative bileaflet mitral valve disease underwent video-assisted minimally invasive right anterolateral thoracotomy repair at a single institution. In all cases, the repair was based on the Re-Lock maneuver. Patients were classified according to the need for anterior intervention. Group 1 included patients receiving Re-Lock only (n = 33), in whom anterior billowing or mild prolapse became competent after posterior correction and required no additional repair. Group 2 included patients receiving Re-Lock + anterior expanded polytetrafluoroethylene neochordae (n = 107), in whom true anterior prolapse or flail warranted targeted neochordal implantation. Follow-up was completed through scheduled clinical and echocardiographic evaluations, with a median duration of 10.2 years. Results: Technical success with freedom of mitral regurgitation (mild or less on intraoperative transesophageal echocardiography) was 99.3%, with no 30-day mortality. At 10 years, overall survival was 95.7%. Freedom from mitral regurgitation 2+ or greater was 91.2%, and freedom from reoperation was 96.4%. Postoperative New York Heart Association class improved in 130 of 140 patients (92.9%) and maintained class I at last follow-up in 122 of 130 survivors (93.8%). No statistically significant difference was observed in outcomes by technique group (log-rank Conclusions: The minimally invasive Re-Lock technique provides safe, reproducible, and effective long-term results for complex bileaflet mitral valve disease, including Barlow's pathology.
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