Analysis of therapeutic decision-making process and prognosis in patients referred to the Valvular Heart Team for management of mitral regurgitation

Abstract

Introduction

Due to the aging of the population and the diversification of treatment options, finding the right treatment for the right patient becomes a challenge, especially in patients with mitral regurgitation (MR), which is a heterogenous and complex disease, with numerous etiologies. Aims of this study are to describe the profile of patients referred to the Valvular Heart Team (VHT) for management of mitral regurgitation, to highlight the selection process and the main factors guiding allocation for different treatment options, to assess clinical outcomes after treatment.

Method

All patients with mitral regurgitation referred to the VHT between January 1st, 2014, and April 30th, 2021, in University Hospital of Tours, were included.

Results

MR patients referred to our VHT were, mostly, old (mean: 74.2 years), symptomatic (96%), at high or intermediate risk according to “European Society of Cardiology” criteria (44%). Most of them had comorbidities, 34% had LVEF < 50% and 70% a severe primary MR. In 81% of cases, invasive management was decided (surgery [44%], percutaneous edge- to-edge mitral repair [TEER] [35%], transcatheter mitral valve replacement [1.6%]) and in 19% of cases, medical treatment was decided. Distribution of treatments changed significantly (P < 0.01) over time, with a progressive increase in TEER. History of cardiac surgery (P = 0.015), EuroScore II > 4% (P = 0.012), STS score > 8% (P = 0.037), frailty according to the Katz index (P = 0.029), LVEF < 50% (P < 0.001), TAPSE < 15 mm (P < 0,01) secondary MR (P < 0.001) and leaflets calcifications (P = 0.027) were the main factors significantly associated with the choice of a conservative treatment. In 86% of cases, VHT decisions could be implemented.

Conclusion

VHT is a centerpiece in the current management of patients with MR, it opts and more and more, for percutaneous treatments. The organization and the smooth running of VHT meetings will be a real issue in the future, with the increase in patients referred and we will have to find solutions (Fig. 1).