Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
Clin Res Cardiol. 2021 Dec;110(12):1881-1889. doi: 10.1007/s00392-021-01844-9. Epub 2021 Apr 1.
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.
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%).
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.
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.
巴洛氏病代表了与反流（MR）、瓣叶组织过多和脱垂相关的广泛二尖瓣病理学谱。修复策略范围从使用瓣环成形术加人工腱索的复杂修复到仅瓣环成形术。后者需要对称的脱垂模式和中央反流射流。我们旨在评估对称和不对称巴洛氏病的修复成功率和耐久性、存活率和术中结果。
在 2009 年 9 月至 2023 年 3 月期间，有 103 名（1939 名接受二尖瓣手术的患者中有 103 名）患者因巴洛氏病就诊。所有患者均通过小开胸手术接受了瓣环成形术加人工腱索（n=71）或仅瓣环成形术（n=31）治疗。有 1 例因心内膜炎更换瓣膜（修复率：99%）。
仅行瓣环成形术的患者年龄较大（64±16 岁 vs. 55±11 岁，p=0.008），且风险较高（EuroSCORE II：4.2±4.9 岁 vs. 1.6±1.7 岁，p=0.007）。仅行瓣环成形术的患者的体外循环时间更短（53±18 分钟 vs. 76±23 分钟，p<0.001），且接受三尖瓣瓣环成形术的比例更高（15.5% vs. 48.4%，p<0.001）。手术时间相似（170±41 分钟 vs. 164±35 分钟，p=0.455）。在 3 名患者中，仅行瓣环成形术导致术中收缩期前向运动（SAM），而后叶人工腱索完全解决了这一问题。30 天内无中转开胸或死亡病例。有 3 名患者因复发性 MR（25 天、2.8 年和 7.8 年）需要再次手术。在最新随访中，81.4%的患者无 MR，14.7%的患者为轻度 MR，2.9%的患者为中度 MR。有 3 名患者因非心脏原因死亡。存活患者报告无相关症状。
微创巴洛氏病修复是安全的，具有良好的耐久性。对于复杂但对称的病变，仅行瓣环成形术可能是一种简单的解决方案。然而，它可能会增加术中 SAM 的风险。
