Nearly five-year prognosis of Barlow mitral valvuloplasty with thoracoscopic and standard median sternotomy:A single center retrospective study
PENG Yong-bu
GUO Chao
WANG Yi-xuan
LI Fei
CHEN Si
ZHOU Cheng
SU Wei
DONG Nian-guo
Abstract：Objective To investigate the practical application and nearly five-year prognosis of two mitral valvuloplasty surgical approaches,the video-assisted minithoracotomy(VAMT)and the standard median sternotomy(SMS),in the treatment of Barlow syndrome.Methods A total of 108 patients who underwent Barlow mitral valvuloplasty at Wuhan Union Hospital from January 2019 to December 2024 were included using retrospective analysis,including 42 cases in VAMT group,and 66 cases in SMS group.The preoperative history data,extracorporeal circulation time,aortic block time,combined tricuspid valvuloplasty cases,total blood transfusion volume,drainage volume,mechanical ventilation time,postoperative ICU stay,postoperative hospitalization time and postoperative complications were observed in both groups.Subsequently,the regression was followed up.Results The general conditions of the patients in the VAMT and SMS groups were comparable,and all of them were able to undergo Barlow mitral valvuloplasty satisfactorily.There were no postoperative complications such as in-hospital death,reopening of the chest for excessive drainage,acute renal failure and cerebrovascular accident in both groups,so the difference was not statistically significant(P＞0.05).But,one case of low cardiac output syndrome was seen in the VAMT group.Furthermore,the VAMT group showed longer extracorporeal circulation time[(149.7±41.5)min vs.(98.0±22.5)min,P＜0.05]and aortic obstruction time[(93.1±32.1)min vs.(68.0±17.8)min,P＜0.05]than the SMS group,but was superior to the SMS group in terms of the duration of mechanical ventilation[(5.8±3.9)h vs.(8.3±2.3)h,P＜0.05],ICU stay[(18.2±4.2)h vs.(30.3±3.5)h,P＜0.05],postoperative hospitalization[(5.0±0.2)d vs.(8.4±0.5)d,P＜0.05],postoperative drainage volume in the 24-hour postoperative period[(80.5±40.2)ml vs.(350±91.4)ml,P＜0.05]and total blood transfusion volume(P＜0.05).In addition,the differences in cardiac function grades,left ventricular end-diastolic internal diameter(LVEDD)[(4.4±0.8)cm vs.(4.3±0.8)cm,P＞0.05],ejection fraction[(58.0±4.0)％vs.(59.0±3.0)％,P＞0.05],reoperation rates of the corresponding valves,recurrence and correction of mitral regurgitation,mitral stenosis,tricuspid valve repair,and out-of-hospital mortality rates between the two groups during 1 year after surgery were not statistically significant(P＞0.05).Conclusion Thoracoscopic valvuloplasty is a powerful weapon to meet the challenges of valvular interventions and is superior to conventional median incision surgery in many aspects.The management of Barlow lesion should be based on an annulus-prioritized repair strategy.Furthermore,the use of a large annulus and the reduction of the posterior valve height can effectively avoid the postoperative mitral systolic anterior motion(SAM),which is a critical factor in the management of Barlow mitral valvuloplasty.
Keywords：ThoracoscopicStandard median sternotomyBarlow mitral valvuloplasty
Publication Date：2025-04-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 298-303 )