Minimally invasive or conventional edge-to-edge repair for severe mitral regurgitation due to bileaflet prolapse in Barlow's disease: Does the surgical approach have an impact on the long-term results

Michele De Bonis, Elisabetta Lapenna, Benedetto Del Forno, Stefania Di Sanzo, Andrea Giacomini, Davide Schiavi, Luca Vicentini, Azeem Latib, Alberto Pozzoli, Federico Pappalardo, Giovanni La Canna, Ottavio Alfieri

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)131-136
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number1
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Keywords

  • Barlow's disease
  • Minimally invasive
  • Mitral regurgitation
  • Mitral valve repair
  • Right minithoracotomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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