TY - JOUR
T1 - Presentation and outcomes of mitral valve surgery in France in the recent era
T2 - A nationwide perspective
AU - Messika-Zeitoun, David
AU - Candolfi, Pascal
AU - Enriquez-Sarano, Maurice
AU - Burwash, Ian G.
AU - Chan, Vincent
AU - Philippon, Jean Francois
AU - Toussaint, Jean Manuel
AU - Verta, Partrick
AU - Feldman, Ted E.
AU - Iung, Bernard
AU - Glineur, David
AU - Obadia, Jean Francois
AU - Vahanian, Alec
AU - Mesana, Thierry
N1 - Funding Information:
Funding This study was funded through a research contract between International Health Market Trends and Edwards Lifesciences. DM-Z had full access to the data and performed the statistical analyses independently.
Funding Information:
Competing interests DM-Z is a consultant for Edwards Lifesciences, Mardil and Cardiawave and receives research grants from Edwards Lifesciences and Abbott vascular. PC is an Edwards Lifesciences employee. M-ES has received research grants from Edwards Lifesciences. PV is an Edwards Lifesciences employee. TEF is an Edwards Lifesciences employee. BI has received consultant fees from Edwards Lifesciences and speaker’s fees from Boehringer Ingelheim and Novartis. J-FO has received Consultant fees from Landanger, Delacroix-Chevalier and speaker’s fees from Abbott, Medtronic, Sanofi. AV has received speaker’s fees from Edwards Lifesciences.
Publisher Copyright:
©
PY - 2020/8/11
Y1 - 2020/8/11
N2 - Objectives Unbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the nationwide level are scarce and mainly US-based. The Programme de Médicalisation des Systèmes d'Information, a mandatory national database, offers the unique opportunity to assess the presentation and outcomes of all consecutive mitral valve (MV) surgeries performed in France in the contemporary era. Methods We collected all MV surgeries performed for MR in France in 2014-2016. MR aetiology was classified as degenerative (DMR), secondary (SMR) or Other (rheumatic or congenital disease and infective endocarditis). Results During the 3-year period, 18 167 MV surgeries were performed in France (55% repair and 45% replacement; 52% isolated). Age was 66±12 years and 59% were male. Aetiology was DMR in 42%, SMR in 16% and other in 42% including 19% with uncertain aetiologies. Overall, in-hospital mortality was 6.5% and increased with age, female gender, Charlson Comorbidity Index, type of surgery (replacement vs repair), associated surgery (combined vs isolated) and MR aetiology (all p<0.01). In-hospital mortality and rate of death/readmission for heart failure (HF) at 1 year were 3.4% and 13%, respectively for DMR (2.4% and 11% for isolated DMR) and 7.8% and 27%, respectively for SMR (5.5% and 23% for isolated SMR). Repair rate was 55% overall, 68% in DMR and 72% for isolated DMR surgery (70% of all DMR). Repair rates decreased with age, Charlson Comorbidity Index and female sex (all p<0.0001). Conclusion In this cross-sectional contemporary prospective nationwide database, in-hospital mortality and 1 year rate of death and HF readmission were considerable overall and in all subsets. Repair rates were suboptimal overall especially in the elderly and women subsets. These results underline the need to develop strategies to improve management and outcomes of patients with both DMR and SMR.
AB - Objectives Unbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the nationwide level are scarce and mainly US-based. The Programme de Médicalisation des Systèmes d'Information, a mandatory national database, offers the unique opportunity to assess the presentation and outcomes of all consecutive mitral valve (MV) surgeries performed in France in the contemporary era. Methods We collected all MV surgeries performed for MR in France in 2014-2016. MR aetiology was classified as degenerative (DMR), secondary (SMR) or Other (rheumatic or congenital disease and infective endocarditis). Results During the 3-year period, 18 167 MV surgeries were performed in France (55% repair and 45% replacement; 52% isolated). Age was 66±12 years and 59% were male. Aetiology was DMR in 42%, SMR in 16% and other in 42% including 19% with uncertain aetiologies. Overall, in-hospital mortality was 6.5% and increased with age, female gender, Charlson Comorbidity Index, type of surgery (replacement vs repair), associated surgery (combined vs isolated) and MR aetiology (all p<0.01). In-hospital mortality and rate of death/readmission for heart failure (HF) at 1 year were 3.4% and 13%, respectively for DMR (2.4% and 11% for isolated DMR) and 7.8% and 27%, respectively for SMR (5.5% and 23% for isolated SMR). Repair rate was 55% overall, 68% in DMR and 72% for isolated DMR surgery (70% of all DMR). Repair rates decreased with age, Charlson Comorbidity Index and female sex (all p<0.0001). Conclusion In this cross-sectional contemporary prospective nationwide database, in-hospital mortality and 1 year rate of death and HF readmission were considerable overall and in all subsets. Repair rates were suboptimal overall especially in the elderly and women subsets. These results underline the need to develop strategies to improve management and outcomes of patients with both DMR and SMR.
KW - cardiac surgery
KW - mitral regurgitation
KW - mitral valve prolapse
UR - http://www.scopus.com/inward/record.url?scp=85089775950&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089775950&partnerID=8YFLogxK
U2 - 10.1136/openhrt-2020-001339
DO - 10.1136/openhrt-2020-001339
M3 - Article
AN - SCOPUS:85089775950
SN - 2398-595X
VL - 7
JO - Open Heart
JF - Open Heart
IS - 2
M1 - 2020001339
ER -