Factors influencing post-surgical survival in degenerative mitral regurgitation

Steele C. Butcher, Benjamin Essayagh, Ewout W. Steyerberg, Giovanni Benfari, Clemence Antoine, Francesco Grigioni, Thierry Le Tourneau, Jean Christian Roussel, Aniek van Wijngaarden, Nina Ajmone Marsan, Christophe Tribouilloy, Dan Rusinaru, Aviram Hochstadt, Yan Topilsky, Hector I. Michelena, Victoria Delgado, Jeroen J. Bax, Maurice Enriquez-Sarano*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Aims Indications for surgery in patients with degenerative mitral regurgitation (DMR) are increasingly liberal in all clinical guidelines but the role of secondary outcome determinants (left atrial volume index ≥60 mL/m2, atrial fibrillation, pulmonary artery systolic pressure ≥50 mmHg and moderate to severe tricuspid regurgitation) and their impact on post-operative outcome remain disputed. Whether these secondary outcome markers are just reflective of the DMR severity or intrinsically affect survival after DMR surgery is uncertain and may have critical importance in the management of patients with DMR. To address these gaps of knowledge the present study gathered a large cohort of patients with quantified DMR, accounted for the number of secondary outcome markers and examined their independent impact on survival after surgical correction of the DMR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods The Mitral Regurgitation International DAtabase-Quantitative registry includes patients with isolated DMR from centres and results across North America, Europe, and the Middle East. Patient enrolment extended from January 2003 to January 2020. All patients undergoing mitral valve surgery within 1 year of registry enrolment were selected. A total of 2276 patients [65 (55–73) years, 32% male] across five centres met study eligibility criteria. Over a median follow-up of 5.6 (3.6 to 8.7) years, 278 patients (12.2%) died. In a comprehensive multivariable Cox regression model adjusted for age, EuroSCORE II, symptoms, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LV ESD) and DMR severity, the number of secondary outcome determinants was independently associated with post-operative all-cause mortality, with adjusted hazard ratios of 1.56 [95% confidence interval (CI): 1.11–2.20, P = 0.011], 1.78 (95% CI: 1.23–2.58, P = 0.002) and 2.58 (95% CI: 1.73–3.83, P < 0.0001) for patients with one, two, and three or four secondary outcome determinants, respectively. A model incorporating the number of secondary outcome determinants demonstrated a higher C-index and was significantly more concordant with post-operative mortality than models incorporating traditional Class I indications alone [the presence of symptoms (P = 0.0003), or LVEF ≤60% (P = 0.006), or LV ESD ≥40 mm (P = 0.014)],

Original languageEnglish
Pages (from-to)871-881
Number of pages11
JournalEuropean Heart Journal
Volume44
Issue number10
DOIs
StatePublished - 7 Mar 2023
Externally publishedYes

Funding

FundersFunder number
Mayo Foundation for Medical Education and Research
Fondation GenaVie
European Society of Cardiology
Fondation Cœur et Recherche
Fédération Française de Cardiologie
TLT
European Society of Contraception and Reproductive HealthApp000080404
Ministère des Affaires Sociales et de la SantéAPI12/N/019

    Keywords

    • Atrial fibrillation
    • Left atrial volume index
    • Pulmonary artery systolic pressure
    • Tricuspid regurgitation

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