Clinical Presentation and Midterm Results of Mitral Valve Surgery for Calcified Mitral Valve Disease---the MITRACURE Registry

Abstract

Background: Calcified mitral valve disease (CMVD) is an increasingly recognized condition associated with specific management challenges. MITRACURE, a large, multicenter, observational registry conducted in France and Canada, provides real-world insights into the characteristics and outcomes of patients with CMVD undergoing MV surgery.

Methods: Among the 3522 patients included in MITRACURE, patients identified with CMVD were matched 4:1 for age, sex, and concomitant procedures with patients with myxomatous MV disease.

Results: Sixty patients (2%) with CMVD were matched to 240 with myxomatous MV disease. Compared with the myxomatous cohort, CMVD patients had a greater burden of cardiovascular risk factors, more comorbidities, and a more advanced presentation, with 70% vs 52% in New York Heart Association class III or IV (P = 0.01). In-hospital mortality and major complication rates (composite of death, cardiogenic shock/low cardiac output requiring inotropes, acute renal failure requiring dialysis, and stroke or transient ischemic attack) were significantly higher in CMVD than in myxomatous patients (20% vs 4% and 38% vs 20%, both P < 0.01). The median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) measure was slightly higher in CMVD patients (3.5 [interquartile range 2.2-5.7]) compared to those with myxomatous disease (2.6 [interquartile range 1.5-4.2], P < 0.01). However, the observed mortality in the CMVD group was 3-4 times higher than predicted, whereas in the myxomatous group it was consistent with predicted values.

Conclusions: CMVD defines a high-risk surgical population with substantial baseline cardiovascular morbidity and markedly elevated postoperative mortality and complication rates that were substantially underestimated by EuroSCORE II emphasizing the need for refined risk prediction models and individualized management strategies in this subset of patients.

Keywords: mitral annular calcification; mitral regurgitation; outcome and risk score; surgery.