Durable robotic mitral repair of degenerative primary regurgitation with long-term follow-up.

Abstract Background Variation in degenerative mitral morphology may contribute to suboptimal repair rates. This study evaluates outcomes of a standardized mitral repair technique. Methods An institutional clinical registry was used to identify 1036 consecutive patients undergoing robotic mitral surgery between 2005-2020: 87% (n=902) had degenerative disease. Calcification, failed transcatheter repair, and endocarditis were excluded, leaving 582 (68%) patients with isolated posterior leaflet and 268 (32%) with anterior/bileaflet prolapse. Standardized repair comprised triangular resection and true-sized flexible band in posterior leaflet prolapse. Freedom from >2+ moderate mitral regurgitation stratified by prolapse location was assessed using competing risk analysis with death as a competing event. Median follow-up was 5.5 (range 0-15) years. Results Of patients with isolated posterior leaflet prolapse, 87% (n=506) had standardized repairs, and 13% (n=76) had additional or non-resectional techniques, versus 24% (n=65) and 76% (n=203) respectively for anterior/bileaflet prolapse (P 2+ regurgitation or reintervention at 10 years was 92% for posterior prolapse (versus 83% for anterior/bileaflet prolapse). Anterior/bileaflet prolapse was associated with late >2+ regurgitation (HR 3.0, 95% CI 1.3-7.0). Conclusions Posterior leaflet prolapse may be repaired in > 99% of patients using triangular resection and band annuloplasty, with satisfactory long-term durability. Increased risk of complex repairs and inferior durability highlights the value of identifying anterior and bileaflet prolapse pre-operatively.