Mitral repair with the sole use of a semi-rigid band in a sub-population of patients with Barlow's disease: a 4-year follow-up with stress echocardiography

Paulis, Ruggero De; Maselli, Daniele; Salica, Andrea; Leonetti, Stefania; Wolf, Lorenzo Guerrieri; Weltert, Luca; Nardella, Saverio; Bellisario, Alessandro

doi:10.1093/icvts/ivv170

Cited by 15 publications

(23 citation statements)

References 24 publications

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“…Another important observation of this meta-analysis was that overall surgical volume (ie, number of patients) did not appear to influence early or late surgical outcomes. Comparing six low-volume studies (arbitrarily defined as fewer than 50 cases; one minimally invasive, 23 four sterntomy 7,8,13,19,20 ) with the rest of the cohort, there was no apparent effect of volume on the primary outcome in the meta-regression analysis.…”

Section: Random Effects Modelmentioning

confidence: 96%

“…Of 1122 articles that were retrieved for evaluation, 18 met the inclusion criteria, including one randomized controlled trial, one propensity score matching study, 11 single-arm sternotomy studies, and five single-arm minimally invasive studies (Supplemental Figure 1). 7,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] There was 100% concordance between reviewers equating to a Cohen's k of 1. The mean sample size was 92.5 patients (range, 12 to 250) and the mean follow-up duration was 51.6 months (range, 14 to 138).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Of note, several case series in this study addressed complex mitral valve diseases with a simple or simplified surgical approach. In the sternotomy group, De Paulis and associates 19 and Ben Zekry and colleagues 7 used a sole complete ring. Decoupling of annular and ventricular contraction has been observed to occur in myxomatous disease, such that only restoration of the correct annular size promotes mitral valve competence in certain patients…”

Section: Commentmentioning

confidence: 99%

“…Heterogeneity: I 2 = 52%, τ 2 = 0.1985, p = 0.05 with this disease. 19 Fucci and colleagues 13 and De Bonis and colleagues 22 used edge-to-edge and ring approaches, the latter of which was used in both the minimally invasive and sternotomy groups. The present meta-analysis confirmed that the minimally invasive approach for mitral valve disease was associated with prolonged operation times in terms of CPB and CC times, but no worsening in clinical outcome.…”

Section: Random Effects Modelmentioning

confidence: 99%

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Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Moscarelli

Fattouch

Gaudino

et al. 2020

The Annals of Thoracic Surgery

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Background. There is high demand for minimally invasive mitral valve repair; however, it is unclear whether the minimally invasive approach provides the same performance as conventional sternotomy in a context of complex mitral valve disease. Here, we compared outcomes of minimally invasive and sternotomy procedures for bileaflet and Barlow's mitral valve disease.Methods. We performed a pooled meta-analysis of studies reporting early and late follow-up of mitral valve repair for complex mitral valve regurgitation. The primary outcome was moderate mitral valve regurgitation recurrence and need for reoperation. Secondary outcomes included operation time, reopening for bleeding, associated tricuspid procedures, failed repair, and inhospital mortality. Incidence rates were calculated for long-term follow-up. Effect estimates were calculated as incidence rates with 95% confidence intervals. When Kaplan-Meier curves were available, event rates were estimated from the curves with Plot Digitizer software;

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Section: Random Effects Modelmentioning

confidence: 96%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Random Effects Modelmentioning

confidence: 99%

See 2 more Smart Citations

Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Moscarelli

Fattouch

Gaudino

et al. 2020

The Annals of Thoracic Surgery

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“…In some circumstances bileaflet mitral disease may be corrected with the implantation of a sole complete ring [10]; we use the ring only when billowing or pseudoprolapse is present. A wide central regurgitant jet and symmetric prolapsed bileaflets generally characterize this subgroup.…”

Section: Commentmentioning

confidence: 99%

A Simplified Technique for Complex Mitral Valve Regurgitation by a Minimally Invasive Approach

Saglio¹,

Moscarelli²,

Bari³

et al. 2018

The Annals of Thoracic Surgery

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Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease

et al. 2021

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Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.

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Mitral repair with the sole use of a semi-rigid band in a sub-population of patients with Barlow's disease: a 4-year follow-up with stress echocardiography

Cited by 15 publications

References 24 publications

Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

A Simplified Technique for Complex Mitral Valve Regurgitation by a Minimally Invasive Approach

Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease

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