Survival loss linked to guideline-based indications for degenerative mitral regurgitation surgery

doi:10.1093/ehjci/jeae176

Valvular & structural heart disease

Survival loss linked to guideline-based indications for degenerative mitral regurgitation surgery

Eur Heart J Cardiovasc ImagingPublished 12 Jul 2024Retrospective cohort study

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Authors' conclusion

Waiting for the onset of Class I or isolated Class IIa triggers before operating on DMR patients is associated with postoperative survival loss.

Study context

Population: Patients undergoing surgical correction of severe degenerative mitral regurgitation, Mitral Regurgitation International Database registry603 deaths
Participants: 2,833 patients

Exposure: Class I trigger vs Class IIa trigger vs No trigger
Class I triggern = 1,677
Class IIa triggern = 568
No triggern = 588reference
Outcome: Long-term postoperative survival
Follow-up: 10 years

Methodological detailsinternational registry (MIDA), matched

International registry (MIDA)
Matched

Main finding

As reported in the abstract

Postoperative survival

Class I trigger71.4± 1.9 · %

Class IIa trigger84.3± 2.3 · %

No trigger88.9± 1.9 · %

Class I trigger: Restricted mean survival time (RMST) survival loss 9.4 months; P < 0.001
Class IIa trigger: RMST survival loss 4.9 months; P = 0.001

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk vs no trigger ←→ Higher risk vs no trigger →	HR (95% CI)	P value
Mortality by trigger class — Several Class I criteria vs No trigger · additional death risk	0.512	1.53 (1.42–1.66)
Mortality by trigger class — Class IIa trigger vs No trigger	0.512	1.46 (1.00–2.13)	P = 0.05
	0.512Hazard ratio (log scale)

Outcome	Values	Estimate	P value
Postoperative survival, isolated PH vs none (Class IIa subgroup)	Isolated PH 83.7 ± 2.8 % · No PH 89.3 ± 1.6 %		P = 0.011
Postoperative survival, AF vs none (Class IIa subgroup)	AF 81.8 ± 5.0 % · No AF 88.3 ± 1.5 %		P = 0.023

Mortality by trigger class — ≥1 Class I criterion led to excess mortality: P < 0.001

Original publication

Survival loss linked to guideline-based indications for degenerative mitral regurgitation surgery. Eur Heart J Cardiovasc Imaging. Published 12 July 2024. doi:10.1093/ehjci/jeae176

Read the original article ↗PubMed

Summarised from the published abstract; every number is checked against it