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

GND
128690275
ORCID
0000-0002-2153-2458
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital
Faerber, Gloria;
GND
1132620619
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital
Tkebuchava, Sophie;
GND
1062970365
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital
Diab, Mahmoud;
GND
121635244
ORCID
0000-0001-9442-7141
Affiliation
Department of Internal Medicine I, Jena University Hospital
Schulze, Christian;
GND
137650922
ORCID
0000-0002-1521-3514
Affiliation
Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital
Bauer, Michael;
GND
120602571vvvv
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital
Doenst, Torsten

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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