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

Abstract

OBJECTIVES 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 centers. 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 (a) isolated annuloplasty, (b) use of additional artificial chordae or (c) leaflet resection in patients suffering from Barlow’s disease undergoing minimally invasive mitral valve repair. METHODS A consecutive series of patients suffering from Barlow`s disease undergoing minimally invasive mitral valve surgery (MIMVS) between 2001–2020 were analyzed (n = 246). Patients were grouped and analyzed 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. RESULTS No significant difference was found between the three surgical techniques in regard to the operative safety (p-value = 0.774). The primary outcome did not differ between groups (p-value = 0.244). Operative success was achieved in 93.5% and was lowest in the isolated annuloplasty group (77.1%). Conversion to mitral valve replacement was increased in patients undergoing isolated annuloplasty (p-value < 0.001). CONCLUSIONS Isolated annuloplasty, use of additional artificial chordae and leaflet resection represent feasible techniques in Barlow patients undergoing MIMVS with comparable five-year results. In view of the increased conversion rate in the annuloplasty group, the pathology should not be oversimplified.