Huyghe Simon, Colpaert Bodine, Czapla Jens, Philipsen Tine, Timmermans Frank, Bové Thierry
Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.
Department of Cardiology, University Hospital of Ghent, Ghent, Belgium.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 5;40(3). doi: 10.1093/icvts/ivaf041.
Within the spectrum of degenerative mitral valve (MV) prolapse, Barlow's disease remains a risk factor for suboptimal long-term outcomes after MV repair (MVr). This study reports on the results of MVr through minimally invasive surgery benchmarking patients with Barlow's disease to fibro-elastic deficiency (FED).
Between July 2008 and December 2021, 246 patients underwent MVr for degenerative MV prolapse via minimally invasive surgery, including 180 FED and 66 Barlow patients. Study end-points focused on 10-year survival, MV reoperation and recurrence of MV regurgitation ≥grade 2.
Barlow patients were significantly younger (Barlow: 58 years (IQR 47-67); FED: 68 years (IQR 60-76), P < 0.001), showing more complex MV prolapse than FED patients. The overall 30 day-mortality was 0.4%. Survival at 10 years was 78.8 ± 11.3% and 64.5 ± 7.4% (P = 0.161) in Barlow and FED patients, respectively. The cumulative incidence of MV reoperation at 10 years was comparable between Barlow and FED patients (FED: 9.7 ± 3.1%; Barlow: 8.0 ± 4.7%, P = 0.645). The cumulative incidence of mitral regurgitation recurrence ≥grade 2 was 3.0 ± 1.4% and 6.8 ± 3.1% at 5 and 10 years overall. Mitral regurgitation recurrence rate at 10 years was higher in Barlow patients, but the difference was not significant (FED: 3.3 ± 1.7% at 10 years; Barlow: 11.1 ± 8.7% at 10 years, P = 0.765).
Despite more extensive MV prolapse in Barlow patients, MVr through minimally surgical access can be achieved with a mid-term outcome comparable to patients with FED. Concentrating the expertise to increase the individual surgeon's experience for surgical approach as the MV procedure itself allowed to achieve outcome results concurrent with those reported by high-volume centres.
在退行性二尖瓣脱垂范围内，巴洛氏病仍是二尖瓣修复（MVr）后长期预后欠佳的危险因素。本研究报告了通过微创手术进行二尖瓣修复的结果，将巴洛氏病患者与纤维弹性缺陷（FED）患者作为基准进行对比。
2008年7月至2021年12月期间，246例患者通过微创手术接受了退行性二尖瓣脱垂的二尖瓣修复，其中包括180例FED患者和66例巴洛氏病患者。研究终点集中在10年生存率、二尖瓣再次手术以及二尖瓣反流复发≥2级。
巴洛氏病患者明显更年轻（巴洛氏病：58岁（四分位间距47 - 67岁）；FED：68岁（四分位间距60 - 76岁），P < 0.001），其二尖瓣脱垂比FED患者更复杂。总体30天死亡率为0.4%。巴洛氏病患者和FED患者10年生存率分别为78.8 ± 11.3%和64.5 ± 7.4%（P = 0.161）。巴洛氏病患者和FED患者10年二尖瓣再次手术的累积发生率相当（FED：9.7 ± 3.1%；巴洛氏病：8.0 ± 4.7%，P = 0.645）。二尖瓣反流复发≥2级的累积发生率在总体5年和10年时分别为3.0 ± 1.4%和6.8 ± 3.1%。巴洛氏病患者10年二尖瓣反流复发率更高，但差异不显著（FED：10年时为3.3 ± 1.7%；巴洛氏病：10年时为11.1 ± 8.7%，P = 0.765）。
尽管巴洛氏病患者的二尖瓣脱垂范围更广，但通过微创手术进行二尖瓣修复可取得与FED患者相当的中期预后。由于二尖瓣手术本身能够取得与大容量中心报告的结果相当的成果，集中专业知识以增加个体外科医生的手术经验对于手术方式而言是可行的。
