Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Eur J Cardiothorac Surg. 2024 Jun 3;65(6). doi: 10.1093/ejcts/ezae213.
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 centres. 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 (i) isolated annuloplasty, (ii) use of additional artificial chordae or (iii) leaflet resection in patients suffering from Barlow's disease undergoing minimally invasive MV repair.
A consecutive series of patients suffering from Barlow's disease undergoing minimally invasive MV surgery between 2001 and 2020 were analysed (n = 246). Patients were grouped and analysed 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.
No significant difference was found between the 3 surgical techniques with regard to operative safety (P = 0.774). The primary outcome did not differ between groups (P = 0.244). Operative success was achieved in 93.5% and was lowest in the isolated annuloplasty group (77.1%). Conversion to MV replacement was increased in patients undergoing isolated annuloplasty (P < 0.001).
Isolated annuloplasty, use of additional artificial chordae and leaflet resection represent feasible techniques in Barlow patients undergoing minimally invasive MV surgery with comparable 5-year results. In view of the increased conversion rate in the annuloplasty group, the pathology should not be oversimplified.
巴氏病是二尖瓣（MV）疾病的一种特殊亚形式，其特征为弥漫性组织过多和多节段脱垂。前外侧小开胸术是许多中心治疗 MV 反流的标准入路。目前仍不清楚哪种手术技术能提供最佳效果。因此，本研究旨在比较患有巴氏病的患者接受微创 MV 修复时，（i）单纯瓣环成形术、（ii）使用额外的人工腱索或（iii）瓣叶切除术的手术安全性和中期结果。
对 2001 年至 2020 年期间连续接受微创 MV 手术的巴氏病患者（n=246）进行了分析。根据使用的手术技术对患者进行分组和分析。主要结局是改良二尖瓣学术研究联盟联合终点，包括 5 年内死亡、因修复失败或再次出现严重二尖瓣反流而再次手术。次要结局包括 30 天内的手术成功率和安全性。
3 种手术技术在手术安全性方面无显著差异（P=0.774）。组间主要结局无差异（P=0.244）。手术成功率为 93.5%，单纯瓣环成形术组最低（77.1%）。单纯瓣环成形术患者行 MV 置换术的比例增加（P<0.001）。
在接受微创 MV 手术的巴氏病患者中，单纯瓣环成形术、使用额外的人工腱索和瓣叶切除术都是可行的技术，5 年结果相当。鉴于瓣环成形术组的转化率增加，不应过于简化该疾病的病理。
