Key result
Annuloplasty for atrial secondary MR is linked to ~50% lower recurrence of ≥moderate MR versus ventricular.
Why the study?
Data on MR recurrence and clinical outcomes after mitral valve annuloplasty for atrial secondary mitral regurgitation compared with ventricular secondary mitral regurgitation are scarce.
Does mitral valve annuloplasty result in lower MR recurrence and mortality in patients with atrial secondary mitral regurgitation compared to ventricular secondary mitral regurgitation?
Cohort (n=216)
No
Does mitral valve annuloplasty result in lower MR recurrence and mortality in patients with atrial secondary mitral regurgitation compared to ventricular secondary mitral regurgitation?
Effect estimate: subdistribution HR 0.50 (95% CI 0.29 to 0.88)
Absolute Event Rate: 7% vs 25%
p-value: p=0.016
Mitral valve annuloplasty provides better durability and survival in patients with atrial secondary mitral regurgitation compared to those with ventricular secondary mitral regurgitation.
May support etiology-specific durability expectations after annuloplasty; leaves open randomized confirmation before practice change.
OBJECTIVES: Atrial secondary mitral regurgitation (ASMR) is a clinically distinct form of Carpentier type I mitral regurgitation (MR), rooted in excessive atrial and mitral annular dilation in the absence of left ventricular dysfunction. Mitral valve annuloplasty (MVA) is expected to provide a more durable solution for ASMR than for ventricular secondary MR (VSMR). Yet data on MR recurrence and outcome after MVA for ASMR are scarce. This study sought to investigate surgical outcomes and repair durability in patients with ASMR, as compared with a contemporary group of patients with VSMR. METHODS: Clinical and echocardiographic data from consecutive patients who underwent MVA to treat ASMR or VSMR in an academic centre were retrospectively analysed. Patient characteristics, operative outcomes, time to recurrence of ≥moderate MR and all-cause mortality were compared between patients with ASMR versus VSMR. RESULTS: Of the 216 patients analysed, 97 had ASMR opposed to 119 with VSMR and subvalvular leaflet tethering. Patients with ASMR were typically female (68.0% vs 33.6% in VSMR, p<0.001), with a history of atrial fibrillation (76.3% vs 33.6% in VSMR, p<0.001), paralleling a larger left atrial size (p<0.033). At a median follow-up of 3.3 (IQR 1.0-7.3) years, recurrence of ≥moderate MR was significantly lower in ASMR versus VSMR (7% vs 25% at 2 years, overall log-rank p=0.001), also when accounting for all-cause death as competing risk (subdistribution HR 0.50 in ASMR, 95% CI 0.29 to 0.88, p=0.016). Moreover, ASMR was associated with better overall survival compared with VSMR (adjusted HR 0.43 95% CI 0.22 to 0.82, p=0.011), independent from baseline European System for Cardiac Operative Risk Evaluation II surgical risk score. CONCLUSION: Prognosis following MVA to treat ASMR is better, compared with VSMR as reflected by lower all-cause mortality and MR recurrence. Early distinction of secondary MR towards underlying ventricular versus atrial disease has important therapeutic implications.
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Deferm et al. (2021) conducted a cohort in Atrial secondary mitral regurgitation (n=216). Mitral valve annuloplasty for atrial secondary MR vs. Mitral valve annuloplasty for ventricular secondary MR was evaluated on Recurrence of ≥moderate MR (subdistribution HR 0.50, 95% CI 0.29 to 0.88, p=0.016). Mitral valve annuloplasty for atrial secondary mitral regurgitation had lower recurrence of ≥moderate MR at 2 years compared to ventricular secondary MR (7% vs 25%; HR 0.50, 95% CI 0.29-0.88, P=0.016).
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