title: Robotic posterior mitral leaflet repair: neochordal versus resectional techniques.
abstract: BACKGROUND
  Resectional techniques are the established method of posterior mitral valve leaflet repair for degenerative disease; however, use of neochordae in a robotically assisted approach is gaining acceptance because of its versatility for difficult multisegment disease. The purposes of this study were to compare the versatility, safety, and effectiveness of neochordal versus resectional techniques for robotic posterior mitral leaflet repair.
  
  
  METHODS
  From December 2007 to July 2010, 334 patients underwent robotic posterior mitral leaflet repair for degenerative disease by a resectional (n = 248) or neochordal (n = 86) technique. Outcomes were compared both unadjusted and after propensity score matching.
  
  
  RESULTS
  Neochordae were more likely to be used than resection in patients with two (28% versus 13%; p = 0.002) or three (3.7% versus 0.87%; p = 0.08) diseased posterior leaflet segments. Three resection patients (0.98%) but no neochordal patient required reoperation for hemodynamically significant systolic anterior motion. Residual mitral regurgitation (MR) at hospital discharge was similar for matched neochordal versus resection patients (MR 0+, 82% versus 89%; MR 1+, 14% versus 8.2%; MR 2+, 2.3% versus 2.6%; 1 neochordal patient had 4+ MR and underwent reoperation; p = 0.14). Among matched patients, postoperative mortality and morbidity were similarly low.
  
  
  CONCLUSIONS
  Compared with a resectional technique, robotic posterior mitral leaflet repair with neochordae is associated with shorter operative times and no occurrence of systolic anterior motion. The versatility, effectiveness, and safety of this repair make it a good choice for patients with advanced multisegment disease.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates. mihaljt@ccf.org
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Gregory
authors.initials: G
authors.lastname: Pattakos
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Gurjyot
authors.initials: G
authors.lastname: Bajwa
authors.forename: Mislav
authors.initials: M
authors.lastname: Planinc
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Williams
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002815:Chordae Tendineae / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome