Clinical Presentation and Outcomes After Surgery for Mitral Regurgitation: Real-World Insights From the MITRACURE International Registry
- PMID: 40886109
- DOI: 10.1161/CIRCULATIONAHA.124.073674
Clinical Presentation and Outcomes After Surgery for Mitral Regurgitation: Real-World Insights From the MITRACURE International Registry
Abstract
Background: Comprehensive knowledge of the clinical presentation, contemporary management, and outcomes on "all-comer" patients referred for mitral valve surgery (MVS) are critical to evaluate current practice and adherence to guidelines, understand selection biases, and inform key stakeholders on quality improvement.
Methods: MITRACURE is a large international retrospective registry of consecutive adult patients who underwent isolated or combined MVS for mitral regurgitation (MR) in France or Canada in 2019 with in-depth clinical and echocardiographic characterization. Patients operated on for isolated mitral stenosis or who had a prior mitral valve intervention were excluded. Data were obtained from detailed chart abstraction and were site reported.
Results: In 2019, 3522 patients underwent MVS (48% combined) across 40 centers (88±46 MVSs/center, median 80, interquartile [51-131]). Mean age was 65±12 years, and 35% were women. The most common MR etiology was myxomatous (61%), followed by functional (9%), infective endocarditis (9%), and rheumatic disease (7%). MR quantification was performed in only 43%. Advanced clinical presentation was common: 43% were in New York Heart Association class III/IV, 30% exhibited congestive heart failure, 47% were on diuretics, 22% had atrial fibrillation/flutter, 35% presented with reduced ejection fraction, and 22% had pulmonary hypertension (≥50 mm Hg). Most patients were symptomatic or presented with class I/IIa indication for intervention, and an early intervention was performed only in 3% of patients. The repair rate was 62% overall and 80% in myxomatous disease. In-hospital mortality was 4.5% overall but 2.3% in patients with myxomatous MR (1.8% isolated, 3.1% combined).
Conclusions: MITRACURE provides a contemporary, multicenter, "real-world" picture of the clinical presentation, management, and in-hospital outcomes of MVS for MR in two Western countries. Patients were often referred late in the disease process, with few patients undergoing early intervention. The higher mortality and lower repair rates reported may be more reflective of an unselected MR patient population but have room for improvement. Our results underline the need to develop strategies to improve management and outcomes of patients with MR.
Keywords: mitral regurgitation; surgery; valve repair.
Conflict of interest statement
Dr Adams received a research grant from Edwards Lifesciences and consulting fees from Edwards Lifesciences and Corcym. Dr Anselmi received consulting or proctoring fees from Abbott. Dr Bauer received consulting fees from Bayer, AstraZeneca, Bristol-Myers Squibb, Abbott, Occlutech, Pfizer, and Novartis. Dr Bernard received consulting or proctoring fees from Abbott, Edwards Lifesciences, and Medtronic. Dr Bonnet received consulting fees from Medtronic, Edwards Lifesciences, and Biosensors outside the scope of the submitted work. Dr Bouchard received consulting or proctoring fees from Edwards Lifesciences and Atricure. Dr Bouchot received consulting fees from Edwards Lifesciences. Dr Bouleti received consulting and lecture fees from AstraZeneca, Novartis, Boehringer Ingelheim, and Sanofi; a research contract from Janssen; and grants from Pfizer. Dr Chu was supported as the Ray and Margaret Elliott Chair in Surgical Innovation and received speaker honoraria from Medtronic, Edwards Lifesciences, Terumo Aortic, and Artivion. Dr Coisne received consulting or proctoring fees from Abbot Vascular, Edwards Lifesciences, GE Healthcare, Merck Sharp & Dohme, and Pfizer. Dr Dib received consulting fees from Boehringer Ingelheim, AstraZeneca, and Novartis. Dr Doisy received consulting fees from Medtronic and Edwards Lifesciences. Dr Donal received consulting fees from Pfizer. Dr Dreyfus received consulting or proctoring fees from Abbott. Dr Fam received speaker honoraria and consultant fees from Edwards Lifesciences and Abbott. Dr Fiore received research grants from Edwards Lifesciences. Dr Folliguet received research grants from Edwards Lifesciences. Dr Forcillo was part of the advisory board and received speaker and proctor fees and research funds from Edwards Lifesciences and Medtronic. Dr Hammoudi received research grants to the institution or consulting/lecture fees from Boehringer Ingelheim, MSD, Philips, Bayer, AstraZeneca, Bristol-Myers Squibb, Abbott, Occlutech, Pfizer, and Novartis. Dr Harnett received consulting fees from Novartis, Boehringer Ingelheim, and the CPD Network Association and is an advisory board member for vericiguat in heart failure. Dr Kent received research grants from Edwards Lifesciences and consulting fees from Edwards Lifesciences, Corcym, Bristol Myers Squibb, and Artivion. Dr Lavie-Badie received consulting or proctoring fees from Abbott and Edwards Lifesciences. Dr Leroux received consulting or proctoring fees from Abbott. Dr Luong received salary support from the Heart and Stroke Foundation of Canada and the Vancouver Coastal Health Research Institute. Dr Messika-Zeitoun received research grants from Edwards Lifesciences. Dr Nejjari received consulting or proctoring fees from Abbott. Dr Obadia received consulting fees from Carmat/Delacroix-Chevalier/Landanger. Dr Ong received speaker honoraria and consultant fees from Edwards Lifesciences and Abbott. Dr Pellerin was part of the advisory board for Edwards Lifesciences. Dr Sportouch received consulting or proctoring fees from Abbott. Dr Tchétché received consulting fees from Abbott, Boston, Edwards Lifesciences, Medtronic, Venus Medtech, Caranx Medical, Pi-Cardia, and T-Heart. Dr Tourneau received lecture fees from GE Healthcare, Novartis, BMS, and AstraZeneca. Dr Ye received consulting fees from Edwards Lifesciences. None.
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