OBJECTIVES: To clarify whether the results of repair of a complex mitral lesion (Barlow valve) at the intermediate-term follow-up are independent of the mode of surgical access [minithoracotomy vs. median sternotomy (MS)]. METHODS: In a prospective randomized study of mitral repair for Barlow disease using either a minimally invasive (MI) approach or MS, we achieved an average follow-up of 3 years (echocardiography, physical examination and quality of life). Mitral repair was achieved with polytetrafluoroethylene chordal implantation for both leaflets. RESULTS:Both groups included 80 patients. Mechanical ventilation time and intensive care unit and hospital stay were shorter in the MI group (p = 0.01, p = 0.013 and p = 0.02, respectively). During the follow-up, 5 patients in each group (6.25%) displayed mild mitral regurgitation, while 2 patients in each group (2.5%) developed recurrent regurgitation graded as at least moderate/severe. The rate of mitral reoperation was 2.5% in the MI group and 1.25% in the MS group (p = 0.9). The overall follow-up mortality was 3.75% in both the MI and the MS groups. CONCLUSIONS: The 3-year results of repair of Barlow valves were satisfactory irrespective of the approach used to repair the valve. The advantages of MI surgery can be achieved in patients with mitral Barlow disease without concerns over the durability of repair.
RCT Entities:
OBJECTIVES: To clarify whether the results of repair of a complex mitral lesion (Barlow valve) at the intermediate-term follow-up are independent of the mode of surgical access [minithoracotomy vs. median sternotomy (MS)]. METHODS: In a prospective randomized study of mitral repair for Barlow disease using either a minimally invasive (MI) approach or MS, we achieved an average follow-up of 3 years (echocardiography, physical examination and quality of life). Mitral repair was achieved with polytetrafluoroethylene chordal implantation for both leaflets. RESULTS: Both groups included 80 patients. Mechanical ventilation time and intensive care unit and hospital stay were shorter in the MI group (p = 0.01, p = 0.013 and p = 0.02, respectively). During the follow-up, 5 patients in each group (6.25%) displayed mild mitral regurgitation, while 2 patients in each group (2.5%) developed recurrent regurgitation graded as at least moderate/severe. The rate of mitral reoperation was 2.5% in the MI group and 1.25% in the MS group (p = 0.9). The overall follow-up mortality was 3.75% in both the MI and the MS groups. CONCLUSIONS: The 3-year results of repair of Barlow valves were satisfactory irrespective of the approach used to repair the valve. The advantages of MI surgery can be achieved in patients with mitral Barlow disease without concerns over the durability of repair.
Authors: Rebecca H Maier; Adetayo S Kasim; Joseph Zacharias; Luke Vale; Richard Graham; Antony Walker; Grzegorz Laskawski; Ranjit Deshpande; Andrew Goodwin; Simon Kendall; Gavin J Murphy; Vipin Zamvar; Renzo Pessotto; Clinton Lloyd; Malcolm Dalrymple-Hay; Roberto Casula; Hunaid A Vohra; Franco Ciulli; Massimo Caputo; Serban Stoica; Max Baghai; Gunaratnam Niranjan; Prakash P Punjabi; Olaf Wendler; Leanne Marsay; Cristina Fernandez-Garcia; Paul Modi; Bilal H Kirmani; Mark D Pullan; Andrew D Muir; Dimitrios Pousios; Helen C Hancock; Enoch Akowuah Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692