Robotic repair for Barlow mitral regurgitation: Repairability, safety, and durability

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 167; no. 2; pp. 636 - 644.e1
• Main Authors: Rowe, Georgina, Gill, George, Trento, Alfredo, Emerson, Dominic, Roach, Amy, Peiris, Achille, Cheng, Wen, Egorova, Natalia, Chikwe, Joanna
• Format: Journal Article
• Language: English
• Published: United States 01.02.2024
• Subjects: Humans; Middle Aged; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Mitral Valve Prolapse - diagnostic imaging; Mitral Valve Prolapse - surgery; Prospective Studies; Robotic Surgical Procedures - adverse effects; Treatment Outcome; minimally invasive; mitral repair; mitral replacement; mitral regurgitation; robotic
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2022.05.033

In Barlow disease, increased repair complexity drives decreased repair rates. We evaluated outcomes of a simplified approach to robotic mitral repair in Barlow disease. A prospective institutional registry with vital-statistics, statewide admissions and echocardiographic follow-up was used to identify 924 consecutive patients undergoing robotic surgery for degenerative mitral regurgitation (MR) between 2005 and 2020, including 12% (n = 111) with Barlow disease. Freedom from >moderate (>2+) MR was analyzed with death as a competing risk and predictors of failure were analyzed using multivariable Cox regression. Median follow-up was 5.5 years (range, 0-15 years). Patients with Barlow disease were younger (median, age 59 years; interquartile range [IQR], 51-67 vs 62; IQR, 54-70 years, P = .05) than patients without Barlow disease. Replacements were performed in 0.9% (n = 1) of patients with Barlow disease and 0.8% (n = 6) of patients without Barlow disease (P = 1). Repairs comprised simple leaflet resection and annuloplasty band in 73.9% (n = 546) of non-Barlow valves versus 12.7% (n = 14) of patients with Barlow disease who required neochordae (53.6%, n = 59), chordal transfer (20%, n = 22), and commissural sutures (37.3%, n = 41), with longer cardiopulmonary bypass time (median 133; IQR, 117-149 minutes vs 119; IQR, 106-142 minutes, P < .01). Survival free from greater than moderate MR at 5 years was 92.0% (95% confidence interval [CI], 80.2%-98.1%) in patients with Barlow disease versus 96.0% (95% CI, 93.3%-98.0%) in patients without Barlow disease (P = .40). Predictors of late failure included Barlow disease (hazard ratio, 3.9; 95% CI, 1.7-9.0) and non-Barlow isolated anterior leaflet prolapse (hazard ratio, 5.6; 95% CI, 2.3-13.4). Barlow disease may be reliably and safely repaired with acceptable long-term durability by experienced robotic mitral surgery programs.