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

Leo Pölzl1, Can Gollmann-Tepeköylü1, Felix Nägele1

  • 1Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|May 23, 2024
PubMed
Abstract

Insights

For Barlow's disease mitral valve repair, isolated annuloplasty, artificial chordae, and leaflet resection showed similar 5-year outcomes. However, isolated annuloplasty had a higher conversion rate to valve replacement.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Disease
  • Minimally Invasive Surgery

Background:

  • Barlow's disease is a specific mitral valve (MV) condition with excessive tissue and multi-segment prolapse.
  • Minimally invasive MV repair via anterolateral mini-thoracotomy is a standard approach for MV regurgitation.

Purpose of the Study:

  • To compare operative safety and mid-term outcomes of three minimally invasive MV repair techniques for Barlow's disease.
  • Techniques compared: isolated annuloplasty, artificial chordae, and leaflet resection.

Main Methods:

  • Analysis of 246 consecutive patients with Barlow's disease undergoing minimally invasive MV surgery (2001-2020).
  • Patients grouped by surgical technique: isolated annuloplasty, artificial chordae, or leaflet resection.
  • Primary outcome: 5-year composite of mortality, reoperation for repair failure, or severe mitral regurgitation recurrence.

Main Results:

  • No significant differences in operative safety or 5-year primary outcomes among the three techniques.
  • Overall operative success rate was 93.5%.
  • Isolated annuloplasty group showed a significantly higher rate of conversion to MV replacement (P < 0.001).

Conclusions:

  • Isolated annuloplasty, artificial chordae, and leaflet resection are feasible for minimally invasive MV repair in Barlow's disease with comparable 5-year results.
  • The increased conversion rate with isolated annuloplasty suggests this technique should be carefully considered.
  • The complexity of Barlow's disease pathology should not be underestimated.
Keywords:
Barlow’s diseaseCardiac surgeryMinimal invasive surgeryMitral valve regurgitation

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