COMPARISON OF SURGICAL TECHNIQUES IN BARLOW’S DISEASE

Backgroud and aim: Barlow’s syndrome is the most advanced and complex in the spectrum of degenerative mitral valve disease; several strategies have been described to face it according to the amount and symmetry of the scallops involved. The aim of this report is to assess repair success and durability, early and late survival, and peri-operative outcomes of patients undergoing surgery for severe mitral valve (MV) regurgitation in Barlow’s disease. Methods: Patients with diagnosis of Barlow’s disease undergoing minimally invasive MV surgery from 2010 to 2024 were retrospectively analyzed and divided according to the received operation: ring only, ring+ posterior leaflet (PL) surgery, or ring + anterior or bileaflet. Results: 199 patients underwent minimally invasive MV surgery: 34 patients received isolated anuloplasty, 99 ring+PL surgery, and 66 ring+anterior/bileaflets surgery. No peri-operative mortality was reported, while stroke occurred in 1 case. Systolic anterior motion occurred in 7 patients and was addressed intra- operatively. Pre-discharge transthoracic echocardiography showed absence of systolic anterior motion, and no or trace of mitral regurgitation. Recurrence of moderate to severe MV regurgitation or redo was 5.9% in the ring only group, 1% in the ring+PL group, and 3% in the ring+anterior/bileaflet group (p=0.03). Conclusion: Minimally-invasive Barlow’s repair is safe and effective at long-term follow- up. No differences in terms of mortality and major complications have been observed among groups. The ring group only presents A higher rate of recurrence of mitral regurgitation was reported in the ring-only group.