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OBJECTIVE: It has been previously reported that the results of valve repair for complex mitral lesion (Barlow valve) via right minithoracotomy is noninferior to the median sternotomy approach at the earliest follow-up. We addressed whether such results are maintained at the intermediate-term follow-up.
METHODS: In the setting of a prospective randomized study of mitral repair for Barlow disease (bileaflet prolapse) via the minimally invasive route (MI group) vs. median sternotomy (MS group), we achieved an average three-years clinical and instrumental follow-up. Mitral repair was achieved with polytetrafluoroethylene chordal implantation for both leaflets. In the MI group, we used right minithoracotomy, peripheral cannulation, external aortic clamping, and surgery under direct vision. Follow-up consisted of echocardiography, physical exam and quality-of-life assessment (SF-36 questionnaire) performed at 6-months intervals.
RESULTS: Both groups included 80 patients. While the operative time was significantly longer in the MI group (p=0.03), there was no statistically significant difference in the cardiopulmonary bypass time (p=0.22). Mitral repair could be successfully accomplished in 79 (98.7%) cases in both groups; mechanical ventilation time, intensive care unit and hospital stay were shorter in the MI group (p=0.009, p=0.02 and p=0.01 respectively). During the follow-up, 5 patients in each group (6.25%) displayed residual mild mitral regurgitation, while 2 patients in each group (2.5%) developed recurrent mitral regurgitation graded at least moderate/severe and symptoms of heart failure. For such reason, the rate of mitral reoperation was 2.5% in the MI group and 1.25% in the MS group (p=0.9). The overall mortality at the end of the follow-up was 3.75% in the MI group and 1.25% in the MS group.
CONCLUSIONS: Although Barlow disease entails a global structural weakening of the mitral leaflets, the three-years results of mitral repair are satisfactory. The encouraging early results are maintained over time irrespective to the approach used to repair the valve (minithoracotomy vs. full sternotomy). The advantages of minimally invasive surgery can be confidently achieved in patients with Barlow disease of the mitral valve, without concerns over the durability of repair.