Author + information
- Received September 17, 2007
- Revision received November 14, 2007
- Accepted December 10, 2007
- Published online March 1, 2008.
- 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∥,
- MIDA Investigators
Reprint requests and correspondence:
Dr. Francesco Grigioni, Istituto di Malattie dell’Apparato Cardiovascolare, Ospedale S. Orsola Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
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.
The present study was supported by a grant from the University of Bologna donated by the Foundation Luisa Fanti Melloni for the purpose of furthering cardiovascular research. Dr. Grigioni has received honoraria and travel grants from Edwards Lifesciences. Dr. Enriquez-Sarano is a consultant for and has received grants from Pfizer, AstraZeneca, and Edwards Lifesciences.
- Received September 17, 2007.
- Revision received November 14, 2007.
- Accepted December 10, 2007.
- American College of Cardiology Foundation