Background. Barlow’s disease (BD) of mitral valve (MV) is a frequent challenge for MV repair, both surgical and percutaneous. 

Objectives. The present study sought to evaluate the outcomes of Transcatheter Edge–to-Edge Repair (TEER) therapy  with the Mitraclip system (Abbott Vascular, Menlo Park, CA, USA) in patients with BD. 

Methods. A multicenter retrospective study was performed for evaluating the post-procedural outcomes (at early term and at 3 years-follow up) in patients referred for Mitraclip with a diagnosis of BD, compared with those of patients with MV prolapse without BD (non-BD). 
Results: A total of 138 patients were analyzed (STS mortality score 3.7±2.8%). Despite a more challenging anatomy, the rate of  acute procedural success was similar in BD vs non-BD (94% vs 97% respectively in BD and in non-BD, p =0.48). The number of clip implanted was significantly higher and the procedural time longer in BD (more than 2 implanted clips in 33% of patients with BD and in 20% of those without BD [P = 0.04] and 115 ± 19 vs 104 ± 20 min [P < 0.01], respectively), as well as less durability of procedural results (MR≤2+ at last follow up) (p=0.01); no difference in mortality rate and surgical MV reoperation was found; conversely, BD patients had a trend towards higher risk of heart failure (HF)- hospitalization  (17% vs 7% at 3 years, p= 0.07). The presence of a flail and the post-operative MR grade were factors related to the 3-years rate of HF-hospitalization.

Conclusions: TEER therapy in BD is feasible with a procedural success similar to the one obtained in non-BD but with more complex procedure, a lower durability of the procedural results and a trend towards more HF-hospitalization at follow up, without difference in mortality and MV-surgery. Further studies with longer follow-up, including patients treated with the new generation of the MitraClip and with annuloplasty devices, are needed.