Clinical presentation and outcomes after surgery for mitral regurgitation - Real world insights from the MITRACURE international registry

Abstract Background/Introduction Detailed information on the clinical presentation, contemporary management, and outcomes of all-comer patients referred for mitral valve surgery (MVS) is critical to evaluating current practice, assessing adherence to guidelines, understanding selection biases, and informing key stakeholders about areas for improvement. Purpose The MITRACURE registry aims to provide a real-world, multicenter perspective on MVS for mitral regurgitation (MR) in France and Canada, focusing on patient characteristics, treatment patterns, and early outcomes. Methods MITRACURE is a large international retrospective registry of consecutive adult patients who underwent MVS, combined or isolated, for MR in France and in Canada in 2019, with in-depth clinical and echocardiographic characterization. Patients operated on for isolated mitral stenosis or who had a prior mitral valve intervention were excluded. Data were obtained from detailed chart abstraction and were site reported. Results A total of 3,522 patients underwent MVS (48% combined) across 40 centers (88±46 MVS/center, median 80, IQ[51-131]). Mean age was 65±12 years and 35% were female. Most common MR etiology was myxomatous (61%), followed by functional (9%), infective endocarditis (9%) and rheumatic disease (7%). MR quantification was performed in only 43%. Advanced clinical presentation was common: 43% were in NYHA class III/IV, 30% exhibited congestive heart failure, 47% were on diuretics, 22% in atrial fibrillation/flutter, 35% presented with reduced ejection fraction and 22% with pulmonary hypertension (≥50 mmHg). Most patients were either symptomatic or presented a class I/IIa indication for intervention and an early intervention was only performed in 3% of the population. Repair rate was 62% overall, 80% in myxomatous disease. In-hospital mortality was 4.5% overall, 2.3% in patients with myxomatous valve (1.8% and 3.1% for isolated and combined MVS respectively) (Figure). Conclusion(s) MITRACURE provides a contemporary, multicenter real-world picture of the clinical presentation, management and in-hospital outcomes of MVS for MR in two Western countries. Patients were often referred late in the course of the disease, and only a few underwent an early intervention. Mortality rates were substantial, and repair rates have room for further improvement. Our results underline the need to develop strategies to improve management and outcomes of patients with MR.Figure