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.
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Figure 1 Long-Term Outcome of Mitral Regurgitation Due to Flail Leaflet Under Medical Treatment
Kaplan-Meier curves showing the estimated 8-year cumulative incidence of atrial fibrillation (AFib), heart failure (HF), or mitral valve (MV) surgery/cardiovascular death (CVD) during nonsurgical management of patients (n = 394) with mitral regurgitation due to flail leaflet. The results indicate that patients experienced high rates of adverse events under nonsurgical management, and surgery seemed almost unavoidable at 8 years.
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Figure 2 Independent Associations Between MV Surgical Treatment and Outcome in 394 Patients With Flail Leaflet
Time-dependent analysis shows favorable associations between MV surgery and outcome in patients (n = 394) with degenerative MR due to flail leaflet (after adjusting for age, New York Heart Association functional class, and left ventricular ejection fraction. The results support the rationale for considering MV surgery early in the course of the disease. Cases of perioperative (i.e., <30 days) AFib (n = 24) were excluded from the analysis. Point estimates of hazard ratios (HRs) are graphically depicted as circles, with their 95% confidence intervals (CI) (lines). Abbreviations as in Figure 1.
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Figure 3 Independent Associations Between Surgical Strategy and Outcome in 313 Patients With Flail Leaflet Undergoing MV Surgery
Time-dependent analysis shows favorable associations between MV repair (vs. replacement) and outcome in patients (n = 313) with degenerative MR due to flail leaflet (after adjusting for age, New York Heart Association functional class, and left ventricular end-diastolic diameter and ejection fraction). Mitral valve repair currently seems to be the strategy of choice in degenerative MR. Point estimates of HRs are graphically depicted as circles, with their 95% CI (lines). Abbreviations as in Figures 1 and 2.
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Figure 4 Independent Associations Between Therapeutic Strategy and Outcome in 102 Asymptomatic Patients With LVEF  60%
Time-dependent analysis in asymptomatic patients with normal ventricular function (n = 102) (after adjusting for age) shows favorable associations between prompt surgery (vs. no or delayed surgery) and HF and the combined end point HF/CVD (only CVD failed to reach statistical significance). Mitral valve repair in asymptomatic patients with normal ventricular function seems to prevent cardiac morbidity. Prompt surgery was defined as an operation performed <12 months after echocardiography (delayed surgery as 12 months). Point estimates of HRs are graphically depicted as circles, with their 95% CI (lines). Abbreviations as in Figures 1 and 2.
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