Minimally invasive mitral valve surgery for mitral valve prolapse: a comparison between fibro-elastic deficiency and Barlow's disease.

Objectives: Within the spectrum of degenerative mitral valve (MV) prolapse, Barlow's disease remains a risk factor for suboptimal long-term outcomes after MV repair (MVr). This study reports on the results of MVr through minimally invasive surgery benchmarking patients with Barlow's disease to fibro-elastic deficiency (FED).

Methods: Between July 2008 and December 2021, 246 patients underwent MVr for degenerative MV prolapse via minimally invasive surgery, including 180 FED and 66 Barlow patients. Study end-points focused on 10-year survival, MV reoperation and recurrence of MV regurgitation ≥grade 2.

Results: Barlow patients were significantly younger (Barlow: 58 years (IQR 47-67); FED: 68 years (IQR 60-76), P < 0.001), showing more complex MV prolapse than FED patients. The overall 30 day-mortality was 0.4%. Survival at 10 years was 78.8 ± 11.3% and 64.5 ± 7.4% (P = 0.161) in Barlow and FED patients, respectively. The cumulative incidence of MV reoperation at 10 years was comparable between Barlow and FED patients (FED: 9.7 ± 3.1%; Barlow: 8.0 ± 4.7%, P = 0.645). The cumulative incidence of mitral regurgitation recurrence ≥grade 2 was 3.0 ± 1.4% and 6.8 ± 3.1% at 5 and 10 years overall. Mitral regurgitation recurrence rate at 10 years was higher in Barlow patients, but the difference was not significant (FED: 3.3 ± 1.7% at 10 years; Barlow: 11.1 ± 8.7% at 10 years, P = 0.765).

Conclusions: Despite more extensive MV prolapse in Barlow patients, MVr through minimally surgical access can be achieved with a mid-term outcome comparable to patients with FED. Concentrating the expertise to increase the individual surgeon's experience for surgical approach as the MV procedure itself allowed to achieve outcome results concurrent with those reported by high-volume centres.