Outcomes in Mitral Regurgitation Due to Flail LeafletsA Multicenter European Study
Francesco Grigioni, MD, PhD*,*,
Christophe Tribouilloy, MD, PhD, FACC ,
Jean Francois Avierinos, MD ,
Andrea Barbieri, MD ,
Marinella Ferlito, MD*,
Faouzi Trojette, MD,
Laurence Tafanelli, MD,
Angelo Branzi, MD*,
Catherine Szymanski, MD,
Gilbert Habib, MD,
Maria G. Modena, MD,
Maurice Enriquez-Sarano, MD, FACC|| on behalf of the MIDA Investigators
* University Hospital of Bologna, Bolgona, Italy
University of Amiens, Amiens, France
University of Marseille, Marseille, France
University of Modena, Modena, Italy
|| Mayo Clinic, Rochester, Minnesota.
* Reprint requests and correspondence: Dr. Francesco Grigioni, Istituto di Malattie dell’Apparato Cardiovascolare, Ospedale S. Orsola Malpighi, Via Massarenti 9, 40138 Bologna, Italy. (Email: francesco.grigioni{at}unibo.it).
Objectives: The purpose of this study was to assess incidence and predictors of events associated with nonsurgical and surgical management of severe mitral regurgitation (MR) in European institutions.
Background: The management of patients with MR remains disputed, warranting multicenter studies to define clinical outcome in routine clinical practice.
Methods: The MIDA (Mitral Regurgitation International DAtabase) is a registry created for multicenter study of MR with echocardiographically diagnosed flail leaflet as a model of pure, organic MR. Our cases were collected from 4 European centers. We enrolled 394 patients (age 64 ± 11 years; 67% men; 64% in New York Heart Association functional class I to II; left ventricular ejection fraction 67 ± 10%).
Results: During a median follow-up of 3.9 years, linearized event rates/year under nonsurgical management were 5.4% for atrial fibrillation (AF), 8.0% for heart failure (HF), and 2.6% for death. Mitral valve (MV) surgery was performed in 315 (80%) patients (repair in 250 of 315, 80%). Perioperative mortality, defined as death within 30 days from the operation, was 0.7% (n = 2). Surgery during follow-up was independently associated with reduced risk of death (adjusted hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.21 to 0.84; p = 0.014). Benefit was largely driven by MV repair (adjusted HR vs. replacement 0.37, 95% CI 0.18 to 0.76; p = 0.007). In 102 patients strictly asymptomatic and with normal ventricular function, 5-year combined incidence of AF, HF, or cardiovascular death (CVD) was 42 ± 8%. In these patients, surgery also reduced rates of CVD/HF (HR 0.26, 95% CI 0.08 to 0.89; p = 0.032).
Conclusions: In this multicenter study, nonsurgical management of severe MR was associated with notable rates of adverse events. Surgery especially MV repair performed during follow-up was beneficial in reducing rates of cardiac events. These findings support surgical consideration in patients with MR due to flail leaflets for whom MV repair is feasible.
|
Abbreviations and Acronyms
| | AF = atrial fibrillation | | CI = confidence interval | | CVD = cardiovascular death | | HF = heart failure | | HR = hazard ratio | | LV = left ventricular | | LVEF = left ventricular ejection fraction | | LVESD = left ventricular end-systolic diameter | | MR = mitral regurgitation | | MV = mitral valve | | NYHA = New York Heart Association |
|
Related articles in JACC Imaging:
- Should We Operate on Asymptomatic Patients With Severe Mitral Regurgitation?
- Paul A. Grayburn
JACC Imaging 2008 1: 142-144.
[Full Text]
This article has been cited by other articles:
|
|
|
|
 
D. Rusinaru, C. Tribouilloy, F. Grigioni, J. F. Avierinos, R. M. Suri, A. Barbieri, C. Szymanski, M. Ferlito, H. Michelena, L. Tafanelli, et al.
Left Atrial Size Is a Potent Predictor of Mortality in Mitral Regurgitation Due to Flail Leaflets: Results From a Large International Multicenter Study
Circ Cardiovasc Imaging,
September 1, 2011;
4(5):
473 - 481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Tribouilloy, D. Rusinaru, C. Szymanski, S. Mezghani, A. Fournier, F. Levy, M. Peltier, A. Ben Ammar, D. Carmi, J.-P. Remadi, et al.
Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction
Eur Heart J Cardiovasc Imaging,
September 1, 2011;
12(9):
702 - 710.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Gillinov, T. Mihaljevic, E. H. Blackstone, K. George, L. G. Svensson, E. R. Nowicki, J. F. Sabik III, P. L. Houghtaling, and B. Griffin
Should Patients With Severe Degenerative Mitral Regurgitation Delay Surgery Until Symptoms Develop?
Ann. Thorac. Surg.,
August 1, 2010;
90(2):
481 - 488.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Magne, P. Lancellotti, and L. A. Pierard
Exercise-Induced Changes in Degenerative Mitral Regurgitation
J. Am. Coll. Cardiol.,
July 20, 2010;
56(4):
300 - 309.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Enriquez-Sarano and T. M. Sundt III
Early Surgery Is Recommended for Mitral Regurgitation
Circulation,
February 16, 2010;
121(6):
804 - 812.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. D. Gillam and A. Schwartz
Primum Non Nocere: The Case for Watchful Waiting in Asymptomatic "Severe" Degenerative Mitral Regurgitation
Circulation,
February 16, 2010;
121(6):
813 - 821.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Tribouilloy, F. Grigioni, J. F. Avierinos, A. Barbieri, D. Rusinaru, C. Szymanski, M. Ferlito, L. Tafanelli, F. Bursi, F. Trojette, et al.
Survival Implication of Left Ventricular End-Systolic Diameter in Mitral Regurgitation Due to Flail Leaflets: A Long-Term Follow-Up Multicenter Study
J. Am. Coll. Cardiol.,
November 17, 2009;
54(21):
1961 - 1968.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Pierard and J. Magne
A New Look to an Old Measurement
J. Am. Coll. Cardiol.,
November 17, 2009;
54(21):
1969 - 1970.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Grayburn
Should we operate on asymptomatic patients with severe mitral regurgitation?
J. Am. Coll. Cardiol. Img.,
March 1, 2008;
1(2):
142 - 144.
[Full Text]
[PDF]
|
|
|
|
