Department of Cardiac Surgery, Massachusetts General Hospital, Boston, USA;
Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Ann Cardiothorac Surg. 2013 Nov;2(6):768-73. doi: 10.3978/j.issn.2225-319X.2013.10.07.
Barlow's valve is a clinically important form of degenerative mitral valve (MV) disease that is characterized by unique clinical, echocardiographic and pathological features. Successful and durable repair of Barlow's MV represents a clinical challenge for most cardiac surgeons. An armamentarium of different MV repair techniques may be required, resectional, neochordal or plicational techniques. Although conventional sternotomy remains the mainstay approach for MV surgery in the majority of cardiac surgery centers, minimally invasive surgery (MIS) is becoming increasingly accepted amongst patients, referring physicians and practicing cardiac surgeons. As surgical approaches, instrumentation and operative experience develop, select centers are now performing MIS MV surgery for nearly all MV patients. Although successful Barlow's MV repair is more complex than that for most degenerative pathologies, several centers have published relatively large series of MIS MV repair for Barlow's disease. In this review article, we highlight and compare the early and long-term results of conventional and minimally invasive approaches to Barlow's and bileaflet mitral prolapse disease. Recent studies from various large volume centers around the world have demonstrated equivalent safety and efficacy outcomes of the MIS approach compared to conventional sternotomy surgery. In addition, MIS MV surgery may allow patients to benefit from a cosmetically appealing incision, a faster recovery and a quicker return to normal activities. However, a definite learning curve has been demonstrated for MIS MV surgery. If a patient with Barlow's disease or other complex MV pathology desires to undergo MIS MV surgery, referral to a center and/or surgeon with extensive experience in MIS MV surgery is recommended.
巴洛氏瓣膜是一种具有独特临床、超声心动图和病理学特征的退行性二尖瓣（MV）疾病的重要临床类型。大多数心脏外科医生都面临着成功且持久修复巴洛氏 MV 的临床挑战。可能需要采用不同的 MV 修复技术，包括切除、替换腱索或折叠技术。尽管传统的胸骨切开术仍然是大多数心脏外科中心 MV 手术的主要方法，但微创外科（MIS）越来越被患者、转诊医生和心脏外科医生所接受。随着手术方法、器械和手术经验的发展，一些中心现在几乎对所有 MV 患者都采用 MIS MV 手术。尽管成功修复巴洛氏 MV 比大多数退行性病变更为复杂，但已有几个中心发表了大量关于 MIS 修复巴洛氏病的研究。在这篇综述文章中，我们重点介绍并比较了传统和微创方法治疗巴洛氏和双瓣叶二尖瓣脱垂疾病的早期和长期结果。来自世界各地的多个大样本量中心的最近研究表明，MIS 方法与传统胸骨切开术手术相比，具有同等的安全性和疗效。此外，MIS MV 手术可能使患者受益于美观的切口、更快的康复和更快地恢复正常活动。然而，MIS MV 手术确实存在明确的学习曲线。如果患有巴洛氏病或其他复杂 MV 病变的患者希望接受 MIS MV 手术，建议转至具有丰富 MIS MV 手术经验的中心和/或外科医生处。
