Clinical Presentation and Mid-Term Results of Mitral Valve Surgery for Calcified Mitral Valve Disease - The MITRACURE registry

Abstract

Background: Calcified mitral valve disease (CMVD) is an increasingly recognized condition associated with specific management challenges. MITRACURE, a large multicenter observational registry conducted in France and Canada, provides real-world insights into the characteristics and outcomes of patients with CMVD undergoing MV surgery.

Methods: Among the 3,522 patients included in MITRACURE, patients identified with CMVD were matched 4:1 for age, sex, and concomitant procedures with patients with myxomatous MV disease.

Results: Sixty patients (2%) with CMVD were matched to 240 with myxomatous MV disease. Compared to the myxomatous cohort, CMVD patients had a greater burden of cardiovascular risk-factors, more comorbidities, and a more advanced presentation, with 70% vs. 52% in NYHA class III-IV (P=0.01). In-hospital mortality and major complication rates (composite of death, cardiogenic shock/low cardiac output requiring inotropes, acute renal failure requiring dialysis, and stroke or transient ischemic attack) were significantly higher in CMVD than myxomatous patients (20% vs. 4%, and 38% vs. 20%, both P<0.01). Median EuroSCORE II was slightly higher in CMVD patients (3.5 [IQR 2.2-5.7]) compared with those with myxomatous disease (2.6 [IQR 1.5-4.2], P<0.01). However, the observed mortality in the CMVD group was three to four times higher than predicted, whereas in the myxomatous group it was consistent with predicted values.

Conclusion: CMVD defines a high-risk surgical population with substantial baseline cardiovascular morbidity and markedly elevated postoperative mortality and complication rates that were substantially underestimated by EuroSCORE II emphasizing the need for refined risk prediction models and individualized management strategies in this subset of patients.

Keywords: mitral annular calcification; mitral regurgitation; outcome and risk-scores; surgery.