Contemporary Surgical Outcomes and Repair Rates in Degenerative Mitral Regurgitation: Real World Insights from the International MITRACURE Registry

P0123 

Abstract Submission 

Denis Bouchard (1), Julien Dreyfus (2), Thierry Letourneau (3), Julien Ternacle (4), Michel Pellerin (5), Bernard Iung (6), William Kent (7), Jean-Francois Obadia (8), Michael Chu (9), David Messika-Zeitoun (10)

(1) Montreal Heart Institute, Outremont, QC, (2) Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France, St-Denis, France, (3) CHU Nantes, Nantes, France, (4) CHU de Bordeaux, Bordeaux, France, (5) Montreal Heart Institute, Montreal, QC, (6) Hôpital Bichat, Paris, France, (7) N/A, N/A, (8) Louis Pradel, LYON-Bron, Rhône-Alpes, (9) University of Western Ontario, London, ON, (10) University of Ottawa Heart Institute, Ottawa, Ontario

*Denis Bouchard    -  Contact Me
Montreal Heart Institute

Julien Dreyfus    -  Contact Me
Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France

Thierry Letourneau    -  Contact Me
CHU Nantes

Julien Ternacle    -  Contact Me
CHU de Bordeaux

*Michel Pellerin    -  Contact Me
Montreal Heart Institute

Bernard Iung    -  Contact Me
Hôpital Bichat

William Kent    -  Contact Me
N/A

Jean-Francois Obadia    -  Contact Me
Louis Pradel

*Michael Chu    -  Contact Me
University of Western Ontario

David Messika-Zeitoun    -  Contact Me
University of Ottawa Heart Institute

*Denis Bouchard    -  Contact Me
Montreal Heart Institute

Objective: Myxomatous (degenerative) mitral valve (MV) disease is the leading cause of mitral regurgitation (MR) in Western countries and represents a significant global health burden. With the rise of transcatheter therapies, real-world data on surgical management including repair rates, outcomes, and center-level practices are increasingly needed.
Methods: From MITRACURE, a multicenter registry of 40 centers across Canada and France of consecutive adult patients who underwent surgery for MR in 2019, we selected the subset of patients with myxomatous MR.
Results: MV surgery was performed in 2,135 patients with myxomatous MR (70% male, 65±12 years). Thirty-seven percent were in NYHA III/IV, only 17% were considered asymptomatic, and early intervention was performed in 4%. MV repair was achieved in 80% of patients, with a 6% intraoperative repair failure rate. In-hospital mortality was 2.3%, significantly lower after repair (1.4%) than replacement (6.2%, P<0.0001). Major complications occurred in 20%, with higher rates in replacement and combined procedures (Figure 1). Independent predictors of mortality included NYHA III/IV, type of surgery, and EuroSCORE II. Repair rates declined with age, comorbidities, and complex anatomy, and increased with center volume (68%, 77%, and 84% in low, intermediate, and high-volume centers, respectively; P<0.0001). Sex was not independently associated with repair rates after adjustment.
Conclusions: In this large real-world cohort from two publicly funded healthcare systems, many patients with myxomatous MR were referred late for surgery, and early intervention remained rare. While in-hospital mortality was low overall, outcomes varied across subgroups. MV repair was achieved in the majority of cases but declined with age and MV anatomical complexity. High-volume centers had better outcomes, supporting earlier referral, structured pathways, and surgical centralization to optimize care.

Mitral and Tricuspid Valve