Robotic mitral repair in echocardiographically symmetrical and asymmetrical Barlow’s disease

Background: Robotic mitral valve repair for mitral regurgitation (MR) is increasingly popular due to shorter hospital stays, reduced perioperative pain, and faster recovery. Barlow’s disease is a significant subset of primary MR due to its complex repair requirements. This study presents our surgical and short-term outcomes for patients with Barlow’s disease treated using the da Vinci Xi robotic system. Methods: Since adopting robotic surgery in June 2021, all consecutive patients diagnosed with Barlow’s disease through September 2023 were included. Based on preoperative echocardiography, patients were classified into two groups: “symmetrical”, involving bileaflet prolapse and a central regurgitant jet, and “asymmetrical”, with single-leaflet prolapse and eccentric regurgitation. Results: Thirty-six patients with Barlow’s disease underwent robotic surgery during the study period. Repair success was 100%, with no conversions required. No significant differences were found in baseline characteristics between the prolapse types. Annuloplasty alone was sufficient for the symmetrical group, whereas asymmetrical cases required neochord loops, reflected by shorter aortic cross-clamp (190 vs. 151 min; P=0.034) and aortic cross-clamp (121 vs. 89 min; P=0.003) durations in the symmetrical group. During a median follow-up of 7.5 months, there were no deaths or reinterventions. Additionally, no cases of progression to ≥ moderate MR were observed during the median echocardiographic follow-up of 5.3 months. Conclusions: Robotic repair of Barlow’s disease is safe, feasible, and yields excellent short-term outcomes. For patients with symmetrical prolapse, annuloplasty alone provides effective repair.