Contemporary surgical outcomes and repair rates in degenerative mitral regurgitation: Real-world insights from the international MITRACURE registry.

Abstract

Degenerative mitral valve disease is the leading mitral regurgitation etiology in Western countries, representing a significant health burden. With the rise of transcatheter therapies, real-world data on surgical management, repair rates, outcomes, and center-level practices are increasingly needed. From MITRACURE, a multicenter registry of 40 centers across Canada and France of consecutive adult patients who underwent surgery for mitral regurgitation in 2019, we selected the subset of patients with degenerative mitral regurgitation. Mitral valve surgery was performed in 2135 patients with degenerative mitral regurgitation (70% male, 65 ± 12 years); 37% were in New York Heart Association III/IV, only 17% were considered asymptomatic, and early intervention was performed in only 4%. Mitral valve repair rate was 80%, with a 6% intraoperative repair failure rate. In-hospital mortality was 2.3%: 1.4% for repair versus 6.2% for replacement (P < .0001). Major complications occurred in 20% of patients and was higher for replacement and combined procedures. Independent predictors of mortality included New York Heart Association III/IV, type of surgery, and European System for Cardiac Operative Risk Evaluation 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 < .0001). Sex was not associated with repair rates after adjustment. In this large real-world cohort from 2 publicly funded healthcare systems, many patients with degenerative mitral regurgitation were referred late for surgery, and early intervention was rare. Although in-hospital mortality was low overall, outcomes varied across subgroups. Mitral valve repair declined with age and mitral valve anatomic complexity. High-volume centers had better outcomes, supporting earlier referral, structured pathways, and surgical centralization to optimize care.