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Mid-term Results of Repaired Barlow Mitral Valves via Right Minithoracotomy vs. Median Sternotomy in a Randomized Trial
Giuseppe Nasso1, Vito Romano1, Mario Siro Brigiani1, Raffaele Bonifazi1, Francesco Bartolomucci2, Giuseppe Speziale3.
1Division of Cardiac Surgery, Anthea Hospital, GVM Hospitals of Care and Research, Bari, Italy, 2Division of Cardiology, "L. Bonomo Hospital", Andria, Italy, 3Anthea Hospital, GVM Hospitals of Care and Research, Bari, Italy.

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 follow-up (echocardiography, physical exam and quality-of-life assessment: SF-36 questionnaire). 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.
RESULTS: Both groups included 80 patients. Mechanical ventilation time, 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 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. 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: The three-years results of repair of Barlow valves are satisfactory irrespective to the approach used to repair the valve (minithoracotomy vs. 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.


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