Objective

In Barlow disease, increased repair complexity drives decreased repair rates. We evaluated outcomes of a simplified approach to robotic mitral repair in Barlow disease.

Methods

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).

Results

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).

Conclusions

Barlow disease may be reliably and safely repaired with acceptable long-term durability by experienced robotic mitral surgery programs.

中文翻译：

---

巴洛二尖瓣反流的机器人修复：可修复性、安全性和耐用性

客观的

在巴洛病中，修复复杂性的增加导致修复率降低。我们评估了巴洛病机器人二尖瓣修复的简化方法的结果。

方法

一项包含生命统计数据、全州入院情况和超声心动图随访的前瞻性机构登记系统用于识别2005 年至 2020 年间连续 924 名因退行性二尖瓣反流 (MR) 接受机器人手术的患者，其中 12% (n = 111) 患有巴洛病。将死亡作为竞争风险来分析摆脱 > 中度 (>2+) MR 的情况，并使用多变量Cox 回归分析失败的预测因素。中位随访时间为 5.5 年（范围：0-15 年）。

结果

患有 Barlow 病的患者比没有 Barlow 病的患者更年轻（中位年龄 59 岁；四分位距 [IQR]，51-67 比 62；IQR，54-70 岁，P  = 0.05）。0.9% (n = 1) 的巴洛病患者和 0.8% (n = 6) 的非巴洛病患者进行了置换术 ( P  = 1)。修复包括简单的瓣叶切除和瓣环成形术，其中 73.9%（n = 546）的非巴洛瓣膜患者采用了简单的瓣叶切除和瓣环成形术，而巴洛病患者中则有 12.7%（n = 14）需要新脊索（53.6%，n = 59）、腱索移植（20 %，n = 22）和连合缝合（37.3%，n = 41），心肺转流时间较长（中位数 133；IQR，117-149 分钟 vs 119；IQR，106-142 分钟， P  < .01）。患有 Barlow 病的患者 5 年无大于中度 MR 的生存率为 92.0%（95% 置信区间 [CI]，80.2%-98.1%），而没有患有 Barlow 病的患者则为 96.0%（95% CI，93.3%-98.0%）。巴洛病 ( P  = .40)。晚期失败的预测因子包括 Barlow 病（风险比，3.9；95% CI，1.7-9.0）和非 Barlow 孤立性前叶脱垂（风险比，5.6；95% CI，2.3-13.4）。

结论

通过经验丰富的机器人二尖瓣手术程序，可以可靠、安全地修复巴洛病，并具有可接受的长期耐久性。