TY - JOUR
T1 - Minimally invasive or conventional edge-to-edge repair for severe mitral regurgitation due to bileaflet prolapse in Barlow's disease
T2 - Does the surgical approach have an impact on the long-term results
AU - De Bonis, Michele
AU - Lapenna, Elisabetta
AU - Del Forno, Benedetto
AU - Di Sanzo, Stefania
AU - Giacomini, Andrea
AU - Schiavi, Davide
AU - Vicentini, Luca
AU - Latib, Azeem
AU - Pozzoli, Alberto
AU - Pappalardo, Federico
AU - Canna, Giovanni La
AU - Alfieri, Ottavio
N1 - Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - OBJECTIVES: To evaluate whether the adoption of a right minithoracotomy operative approach had an impact on the long-term results of edge-to-edge (EE) repair compared to conventional sternotomy in patients with Barlow's disease and bileaflet prolapse. METHODS: We assessed the long-term results of 104 patients with Barlow's disease treated with a minimally invasive EE technique. An equal number of patients had a conventional median sternotomy EE repair for the same disease and were used as a control group. The inverse probability of treatment weighting was used to create comparable distributions of the covariates that were significantly different at baseline in the two groups. We performed a comparative analysis of the groups. RESULTS: No hospital deaths were observed. Follow-up was 99.5% complete (median 11.3 years). The cumulative incidence function (CIF) of cardiac death at 12 years, with noncardiac death as a competing risk, showed no difference between the two groups (P = 0.87). At 12 years, the CIF of recurrent MR≥3+, with death as the competing risk, was 7% in the sternotomy group and 5% in the minimally invasive group (P = 0.30), and the CIF of recurrence of MR≥2+ was 15 and 14%, respectively (P = 0.63). The type of surgical approach was not a predictor of cardiac death, reoperation, recurrent MR≥3+ or recurrent MR≥2+. CONCLUSIONS: A minimally invasive approach does not have a negative impact on the effectiveness and long-term durability of the EE repair for bileaflet prolapse in Barlow's disease. Long-term outcomes are excellent, and valvular performance remains stable over time with no evidence of mitral stenosis.
AB - OBJECTIVES: To evaluate whether the adoption of a right minithoracotomy operative approach had an impact on the long-term results of edge-to-edge (EE) repair compared to conventional sternotomy in patients with Barlow's disease and bileaflet prolapse. METHODS: We assessed the long-term results of 104 patients with Barlow's disease treated with a minimally invasive EE technique. An equal number of patients had a conventional median sternotomy EE repair for the same disease and were used as a control group. The inverse probability of treatment weighting was used to create comparable distributions of the covariates that were significantly different at baseline in the two groups. We performed a comparative analysis of the groups. RESULTS: No hospital deaths were observed. Follow-up was 99.5% complete (median 11.3 years). The cumulative incidence function (CIF) of cardiac death at 12 years, with noncardiac death as a competing risk, showed no difference between the two groups (P = 0.87). At 12 years, the CIF of recurrent MR≥3+, with death as the competing risk, was 7% in the sternotomy group and 5% in the minimally invasive group (P = 0.30), and the CIF of recurrence of MR≥2+ was 15 and 14%, respectively (P = 0.63). The type of surgical approach was not a predictor of cardiac death, reoperation, recurrent MR≥3+ or recurrent MR≥2+. CONCLUSIONS: A minimally invasive approach does not have a negative impact on the effectiveness and long-term durability of the EE repair for bileaflet prolapse in Barlow's disease. Long-term outcomes are excellent, and valvular performance remains stable over time with no evidence of mitral stenosis.
KW - Barlow's disease
KW - Minimally invasive
KW - Mitral regurgitation
KW - Mitral valve repair
KW - Right minithoracotomy
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U2 - 10.1093/ejcts/ezx032
DO - 10.1093/ejcts/ezx032
M3 - Article
C2 - 28407104
AN - SCOPUS:85021761502
SN - 1010-7940
VL - 52
SP - 131
EP - 136
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 1
ER -