This Article Figures Only Full Text Full Text (PDF) View CVN News Brief Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JACC Imaging Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grigioni, F. Search for Related Content PubMed Articles by Grigioni, F.

Outcomes in Mitral Regurgitation Due to Flail Leaflets

A 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:

				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]