Contemporary management of patients with native mitral regurgitation in heart valve centres

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.

To investigate characteristics, management and outcomes of patients with native MR referred to HVCs.

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.

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 2years, 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).

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.