• Claudio Muneretto, Gianluigi Bisleri, Lorenzo Bagozzi, Alberto Repossini, Nicola Berlinghieri, and Ermanna Chiari.
• Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy munerett@med.unibs.it.
• Eur J Cardiothorac Surg. 2015 Jan 1; 47 (1): 46-50; discussion 50-1.

ObjectivesMinimally 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.MethodsFifty 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.ResultsAll 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.ConclusionsMinimally invasive approach for complex MV repair is feasible and safe and provided excellent early and mid-term results.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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