Five-year outcomes of different techniques for minimally invasive mitral valve repair in Barlow's disease

• Published in: European journal of cardio-thoracic surgery Vol. 65; no. 6
• Main Authors: Pölzl, Leo, Gollmann-Tepeköylü, Can, Nägele, Felix, Cetin, Kardelen, Spilka, Johannes, Holfeld, Johannes, Oezpeker, Ulvi C, Stastny, Luka, Graber, Michael, Hirsch, Jakob, Engler, Clemens, Dumfarth, Julia, Ruttmann-Ulmer, Elfriede, Hangler, Herbert, Grimm, Michael, Müller, Ludwig, Höfer, Daniel, Bonaros, Nikolaos
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 03.06.2024
• Subjects: Adult; Aged; Conventional Valve Operations; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Mitral Valve - surgery; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Annuloplasty - methods; Mitral Valve Insufficiency - surgery; Mitral Valve Prolapse - surgery; Retrospective Studies; Treatment Outcome; Minimal invasive surgery; Mitral valve regurgitation; Cardiac surgery; Barlow’s disease
• ISSN: 1873-734X; 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezae213

Barlow's disease is a specific sub-form of mitral valve (MV) disease, characterized by diffuse excessive tissue and multi segment prolapse. The anterolateral mini-thoracotomy represents the standard access for MV regurgitation in many centres. It still remains unclear which surgical technique provides the best results. Therefore, the aim of this study was to compare operative safety and mid-term outcomes after (i) isolated annuloplasty, (ii) use of additional artificial chordae or (iii) leaflet resection in patients suffering from Barlow's disease undergoing minimally invasive MV repair. A consecutive series of patients suffering from Barlow's disease undergoing minimally invasive MV surgery between 2001 and 2020 were analysed (n = 246). Patients were grouped and analysed according to the used surgical technique. The primary outcome was a modified Mitral Valve Academic Research Consortium combined end-point of mortality, reoperation due to repair failure or reoccurrence of severe mitral regurgitation within 5 years. The secondary outcome included operative success and safety up to 30 days. No significant difference was found between the 3 surgical techniques with regard to operative safety (P = 0.774). The primary outcome did not differ between groups (P = 0.244). Operative success was achieved in 93.5% and was lowest in the isolated annuloplasty group (77.1%). Conversion to MV replacement was increased in patients undergoing isolated annuloplasty (P < 0.001). Isolated annuloplasty, use of additional artificial chordae and leaflet resection represent feasible techniques in Barlow patients undergoing minimally invasive MV surgery with comparable 5-year results. In view of the increased conversion rate in the annuloplasty group, the pathology should not be oversimplified.