Mitral regurgitation Heart valve centre Heart team Transcatheter edge-to-edge repair Transcatheter mitral valve replacement
Abstract :
[en] Background: Despite a key role in the latest guidelines, the screening process of patients with mitral regurgitation (MR) referred to Heart Valve Centres (HVCs) remains unexplored. Aims: To investigate characteristics, management and outcomes of patients with native MR referred to HVCs. Methods: Between January 2017 and May 2021, all patients with MR referred to seven French HVCs for medico-surgical evaluation were included. Individual management was left to the local interdisciplinary HVC. Patients eligible to mitral valve (MV) intervention were compared with those deemed ineligible and left on medical therapy. The primary endpoint was 2-year all-cause mortality. Results: After exclusion for treatment refusal or non-MV surgery, a total of 823 patients were analysed: 662 eligible versus 161 ineligible to MV intervention. Among the 662 eligible patients, 382 (57.7%) underwent transcatheter edge-to-edge repair, 215 (32.5%) MV surgery, 40 (6.0%) transcatheter MV replacement and 25 (3.8%) were either on the waiting list at the end of follow-up (n = 12) or had died before intervention (n = 13). Ineligible patients had higher surgical risk scores (median EuroSCORE II 4.2% vs. 3.3%; P = 0.003; median Society of Thoracic Surgeons mortality risk score 4.3% vs. 3.5%; P = 0.023) and more advanced left ventricular (LV) impairment (mean LV ejection fraction 49.7% vs. 56.6%; P < 0.001). At 2 years, all-cause mortality was significantly higher in ineligible versus eligible patients (36.3% vs. 18.0%; P < 0.0001). After multivariable adjustment, HVC-defined eligibility for MV intervention was associated with lower 2-year mortality (hazard ratio: 0.54, 95% confidence interval: 0.35-0.84; P = 0.006). Conclusion: HVC interdisciplinary evaluation of severe native MR results in MV intervention in most cases. Eligibility for MV intervention was associated with lower risk of 2-year mortality.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Coisne, Augustin ; Université de Lille, Inserm ; CHU de Lille, Institut Pasteur de Lille, Lille, France ; Cardiovascular Research Foundation, New York, USA ; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA
Scotti, Andrea; Cardiovascular Research Foundation, New York, USA ; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA
Bohbot, Yohann ; Department of Cardiology, Amiens University Hospital, Amiens, France ; UR UPJV 7517, Jules-Verne University of Picardie, Amiens, France
Dreyfus, Julien ; Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
Bernard, Anne; Service de Cardiologie, CHRU de Tours, Tours, France ; EA4245, Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France
Lavie Badie, Yoan; Heart Valve Center, Toulouse University Hospital, Toulouse, France
Rousse, Natacha; Université de Lille, Inserm ; CHU de Lille, Institut Pasteur de Lille, Lille, France
Sudre, Arnaud ; Université de Lille, Inserm ; CHU de Lille, Institut Pasteur de Lille, Lille, France
Tribouilloy, Christophe; Department of Cardiology, Amiens University Hospital, Amiens, France ; UR UPJV 7517, Jules-Verne University of Picardie, Amiens, France
Peltier, Marcel; Department of Cardiology, Amiens University Hospital, Amiens, France ; UR UPJV 7517, Jules-Verne University of Picardie, Amiens, France
Ludwig, Sebastian ; Cardiovascular Research Foundation, New York, USA ; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
Marcheix, Bertrand; Heart Valve Center, Toulouse University Hospital, Toulouse, France
Eyharts, Damien; Heart Valve Center, Toulouse University Hospital, Toulouse, France
Steinecker, Matthieu; Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
Nejjari, Mohammed ; Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
Luciani, Marie; Service de Cardiologie, CHRU de Tours, Tours, France
Saint, Christophe; Service de Cardiologie, CHRU de Tours, Tours, France
Ternacle, Julien; UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France ; Quebec Heart and Lung Institute, Quebec, Canada
Bonnet, Guillaume ; Cardiovascular Research Foundation, New York, USA ; UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
L'official, Guillaume; CHU de Rennes, Cardiologie ; LTSI, Rennes, France
Galli, Elena; CHU de Rennes, Cardiologie ; LTSI, Rennes, France
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation ; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola ; and Anthea Hospital, Bari, Italy
Granada, Juan; Cardiovascular Research Foundation, New York, USA
Donal, Erwan ; CHU de Rennes, Cardiologie ; LTSI, Rennes, France
Modine, Thomas; UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
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