Mid-term clinical outcomes of totally endoscopic repair for mitral regurgitation in Barlow's disease

Objective This study aimed to confirm the safety and feasibility of totally endoscopic repair for mitral regurgitation (MR) in Barlow's disease.Methods From June 2018 to December 2022, 21 consecutive Barlow's disease patients (aged 33 +/- 12 years; 57.1% male) underwent totally endoscopic mitral valve (MV) repair with leaflets folding, multiple artificial chordae implantation and ring annuloplasty. The safety and feasibility of this technique was evaluated by its mid-term clinical outcomes.Results There was no operative death or complications. The mean cardiopulmonary bypass (CPB) time was 190 +/- 41 (128-267) min, and the aortic cross-clamp time was 145 +/- 32 (66-200) min. The average number of artificial chordae implantation was 2.9 +/- 0.7 (1-4) pairs. The mean MV coaptation length was 1.4 +/- 0.3 (0.8-1.8) cm, and the median transvalvular gradient was 1 [interquartile range (IQR), 1-2] mmHg. During a median follow-up time of 24 (IQR, 10-38) months, all patients showed persistent effective valve function with no significant MR or systolic anterior motion.Conclusions Totally endoscopic repair was a safe, effective, and reproducible procedure with satisfied mid-term clinical outcomes for MR in Barlow's disease. However, further randomized and long-term follow-up studies were warranted to determine its clinical effects.