Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
J Thorac Cardiovasc Surg. 2024 Feb;167(2):636-644.e1. doi: 10.1016/j.jtcvs.2022.05.033. Epub 2022 Jun 1.
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.
在巴洛病中，增加的修复复杂性导致修复率降低。我们评估了简化的机器人二尖瓣修复方法在巴洛病中的治疗效果。
采用前瞻性机构注册、全州住院和超声心动图随访的方法，确定了 2005 年至 2020 年间 924 例连续接受机器人手术治疗退行性二尖瓣反流（MR）的患者，其中 12%（n=111）为巴洛病患者。分析了死亡率作为竞争风险的情况下，无>中度（>2+）MR 的比例，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）。
巴洛病患者比无巴洛病患者更年轻（中位数年龄 59 岁；四分位距 [IQR]，51-67 岁比 62 岁；IQR，54-70 岁，P=0.05）。巴洛病患者中有 0.9%（n=1）行瓣膜置换术，无巴洛病患者中有 0.8%（n=6）行瓣膜置换术（P=1）。在非巴洛病瓣膜中，73.9%（n=546）行简单瓣叶切除术和瓣环成形带，而巴洛病患者中需要行人工腱索（53.6%，n=59）、腱索转移（20%，n=22）和交界区缝合（37.3%，n=41），心肺转流时间较长（中位数 133；IQR，117-149 分钟比 119；IQR，106-142 分钟，P<0.01）。巴洛病患者 5 年时无>中度 MR 的生存率为 92.0%（95%置信区间 [CI]，80.2%-98.1%），无巴洛病患者为 96.0%（95% CI，93.3%-98.0%）（P=0.40）。晚期失败的预测因素包括巴洛病（风险比，3.9；95% CI，1.7-9.0）和非巴洛病孤立性前瓣叶脱垂（风险比，5.6；95% CI，2.3-13.4）。
有经验的机器人二尖瓣手术团队可以可靠、安全地修复巴洛病，且长期效果可接受。
