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.
Article Details
Authors (110)
Michael W.A. Chu
Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada (M.W.A.C., L.G.).
Ophélie Brault Meslin
Department of Cardiology, Institut Mutualiste Montsouris, Paris, France (O.B.M.).
George A. Wells
University of Ottawa Heart Institute, Ottawa
William D.T. Kent
Section of Cardiac Surgery, University of Calgary, Calgary, AB, Canada (A.F.H., W.K.).
Yohann Bohbot
Christophe Tribouilloy
Gilles Touati
Loïc Bière
Department of Cardiology, University Hospital of Angers, Angers, France (L.B.).
Olivier Fouquet
Frédéric Rouleau
Dimitri Arangalage
Bernard Iung
Cardiology, Hôpital Bichat, Paris, France (B.I., G.S.).
Julien Ternacle
Unité Médico-Chirurgicale des Valvulopathies, Hôpital Haut-Leveque, CHU Bordeaux, Pessac, France
Guillaume Bonnet
Thomas Modine
Jules Hager
Pierre Gravinay
Martine Gilard
Cardiology Department, CHU Brest, Brest, France
Ange Goutondji
Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France (A.G.).
Olivier Bouchot
Aline Jazayeri
Antonio Fiore
Division of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France (A.F.).
Pascal Lim
Thierry Folliguet
Laura Munte
Cardiac Surgery Department, George Pompidou European Hospital, Paris, France (L.M.).
Paul Achouh
Thiziri Si Moussi
Cardiology Department, Felix Guyon University Hospital, Reunion, France (T.S.M.).
Nadhir Chaban
Augustin Coisne
University Lille, INSERM, CHU Lille, Institut Pasteur de Lille, Lille, France (A.C.).
Marie Jungling
Cédric Robert-Valli
Thays Sokolov
Cardiothoracic Surgery Department, Hospices Civils de Lyon, Claude Bernard University, Lyon, France (T.S., J.-F.O.).
Marco Vola
Jean-François Obadia
Cardiothoracic Surgery Department, Hospices Civils de Lyon, Claude Bernard University, Lyon, France (T.S., J.-F.O.).
Christine Selton-Suty
Cardiology Department, University Hospital of Nancy-Brabois, Nancy, France (C.S.-S.).
Romain Maheut
Olivier Huttin
Thierry Le Tourneau
Nantes Université, CHU Nantes, Centre national de la recherche scientifique, Institut national de la santé et de la recherche médicale, L’Institut du Thorax, France (A.S.B., F.L., S.L.S., F.S., C.D., T.L.T., J.-J.S.).
Thomas Senage
Jean-Christian Roussel
Nadjib Hammoudi
Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institute of Cardiometabolism and Nutrition (ICAN), Institut de Cardiologie Hôpital Pitié-Salpêtrière, Paris, France (N.H.).
Guillaume Lebreton
Paul-Jun Martial
Claire Bouleti
University of Poitiers, Clinical Investigation Center, INSERM 1402, Poitiers, France
Benjamin Alos
Sonia Azzakani
Amedeo Anselmi
Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France (A.A.).
Giuseppe Evangelista
Erwan Donal
Fabrice Bauer
Department of Cardiology, Kremlin-Bicêtre University Hospital, University of Paris-Saclay, Bicêtre, France (F.B.).
Chadi Aludaat
Yoan Lavie-Badie
Heart Valve Center, Toulouse University Hospital, Toulouse, France (Y.L.-B.).
Flavie Abadie
Bertrand Marcheix
Anne Bernard
Service de Cardiologie, CHU Tours, Tours, France (A.B.).
Antonin Fuzeau
Thierry Bourguignon
Benjamin Elegamandji
Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (B.E., J.D.).
Mohammed Nejjari
Julien Dreyfus
Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (B.E., J.D.).
Jean Claude Dib
Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France (J.C.D.).
Catherine Sportouch
Cardiologie Sud de France, Clinique du Millénaire, Montpellier, France (C.S.).
Stéphane Cade
Jean Etienne Ricci
Pierre-Yves Leroux
Cardiology MEDIPOLE Hôpital Privé 69100 Lyon-Villeurbanne, France (P.-Y.L.).
Vincent Doisy
Didier Tchétché
Clinique Pasteur, Toulouse, France
Mauro Boiago
Laurent Lepage
Cardiology, Clinique Pasteur, Toulouse, France (L.L.).
Omar Oliva
Aurélien Seemann
Department of Cardiology, Clinique Saint Gatien NCT, Tours, France (A.S.).
Ophélie Brault-Meslin
Alain Berrebi
Patrick Seknadji
Service de Cardiologie, Hôpital Privé Jacques Cartier, Massy, France (P.S.).
Marine Jullien
Edouard Ballout
Arnaud Maudiere
Division of Cardiac Surgery, St. Joseph Hospital Marseille, France (A.M.).
Remi Houel
Antoine Jeu
Ramsay Santé, Hôpital Privé Le Bois, Lille, France (A.J.).
Omair Arshad
Department of Cardiology, Memorial University, St. John’s, NL, Canada (O.A.).
David T. Harnett
Jean-Francois Legare
New Brunswick Heart Centre, Dalhousie University Medicine, New Brunswick, NB, Canada (J.-F.L.).
Jessica Forcillo
Cardiac Surgery Department, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC, Canada (J.F.).
Philippe Demers
Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada (D.B., P.D.).
Michel Pellerin
Denis Bouchard
Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada (D.B., P.D.).
Bindu Bittira
Division of Cardiac Surgery Health Sciences North, Sudbury, ON, Canada (B.B.).
Linrui Guo
Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada (M.W.A.C., L.G.).
Shahar Lavi
London Health Sciences Centre, University of Western Ontario, London, Canada
Michael W. A. Chu
Usha Manian
Non-Invasive Lead, St. Mary’s Regional Cardiac Care Centre, Kitchener, ON, Canada (U.M.).
Jennifer Higgins
Geraldine Ong
Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada (G.O.).
Neil Fam
Howard Leong-Poi
Angel Yi Nam Fu
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada (D.M.-Z., A.Y.N.F., R.G.).
David Messika-Zeitoun
Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy (G.L.).
Vincent Chan
Jordan Bernick
George Wells
Roja Gauda
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada (D.M.-Z., A.Y.N.F., R.G.).
Malek Kass
Saint Boniface Hospital, Winnipeg, MB, Canada (M.K.).
Steven Promislow
Ali Fatehi Hassanabad
Section of Cardiac Surgery, University of Calgary, Calgary, AB, Canada (A.F.H., W.K.).
Corey Adams
William Kent
Jian Ye
Charmaine Lam
Division of Cardiology, University of British Columbia, Vancouver, BC, Canada (C.L.).
Christina Luong
Mohammad Al-Fadhalah