title: Results of minimally invasive, video-assisted mitral valve repair in advanced Barlow's disease with bileaflet prolapse.
abstract: OBJECTIVE
  Minimally invasive mitral valve (MV) surgery has recently gained popularity as the standard approach for MV repair, albeit there could be potential concerns about the feasibility of complex repair in the presence of extreme Barlow's disease via a minimally invasive route.
  
  
  METHODS
  Fifty consecutive patients with advanced Barlow's disease and bileaflet prolapse underwent minimally invasive, video-assisted MV repair via a 5 cm right antero-lateral thoracotomy with peripheral cannulation and external aortic clamping. Mean age, left ventricular ejection fraction and New York Heart Association class were 53±11 years, 62±7% and 3.1±0.8, respectively. Logistic EuroSCORE (mean) was 3.1. Either Custodiol (36 patients; 72%) or crystalloid (14 patients; 28%) cardioplegia were utilized. Complete rings (CE Classic or Physio) were implanted. Chordal reimplantation was carried out by means of polytetrafluoroethylene (PTFE) chordae.
  
  
  RESULTS
  All procedures were successfully performed with null/mild residual mitral regurgitation (MR) intraoperatively. A repair strategy of posterior leaflet resection and PTFE chordae implant (for anterior leaflet) or no-resect approach (only PTFE chordae on both leaflets) was performed in 62% (31 patients) and 38% (19 patients) of cases, respectively. Mean aortic cross-clamp and cardiopulmonary bypass times were 98±23 and 131±41 min, respectively. Hospital mortality was 0%. At a median follow-up of 761 days, 2 patients (4%) required reoperation (infective endocarditis: 1 patient; partial ring detachment: 1 patient) and valve rerepair was achieved in both. All patients are alive with a freedom from ≥2+ degree of MR of 100% at the latest echocardiographic evaluation.
  
  
  CONCLUSIONS
  Minimally invasive approach for complex MV repair is feasible and safe and provided excellent early and mid-term results.
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy munerett@med.unibs.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Muneretto
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bisleri
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bagozzi
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Repossini
authors.affiliation: Division of Cardiology, University of Brescia Medical School, Brescia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Berlinghieri
authors.affiliation: Division of Cardiology, University of Brescia Medical School, Brescia, Italy.
authors.forename: Ermanna
authors.initials: E
authors.lastname: Chiari
mesh_terms: D005260:Female; D040181:Genetic Diseases, X-Linked / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Barlow; Minimally invasive; Mitral valve; Valve repair