Robotic chordae shortening in mitral valve repair.

Background: Cusp-level chordae shortening was largely abandoned after suboptimal durability in the sternotomy era. We postulated that the enhanced visualization and wristed instrumentation of totally endoscopic robotic mitral repair could enable precise shortening with durable hemodynamics and acceptable peri-operative risk. Methods: We retrospectively analyzed 523 consecutive degenerative mitral regurgitation (MR) repairs performed robotically at the National Taiwan University Hospital (January 2012-November 2024). Chordae shortening was used in 68 patients (13%; 46 primary, 22 adjunct) and compared with 455 contemporaneous repairs without shortening. Results: Baseline characteristics and operative times were similar [cross‑clamp 74±27 Conclusions: Robotic chordae shortening adds negligible operative time, shortens ICU and hospital stay, and delivers long-term valve competence equivalent to contemporary robotic repairs relying on chordal transfer or neochordae. Although new-onset atrial fibrillation was more frequent, other adverse events were rare. The robotic platform appears to overcome historical limitations of chordae shortening, restoring this tissue‑preserving option for anterior leaflet prolapse in degenerative mitral disease.