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Original research
Outcome and durability of mitral valve annuloplasty in atrial secondary mitral regurgitation
  1. Sébastien Deferm1,2,
  2. Philippe B Bertrand1,2,
  3. David Verhaert1,
  4. Jeroen Dauw1,2,
  5. Jan M Van Keer3,
  6. Alexander Van De Bruaene3,
  7. Marie-Christine Herregods3,
  8. Bart Meuris4,
  9. Peter Verbrugghe4,
  10. Steffen Rex5,
  11. Pieter M Vandervoort1,2,
  12. Filip Rega4
  1. 1 Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
  2. 2 Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
  3. 3 Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
  4. 4 Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
  5. 5 Department of Anesthesiology and Intensive Care, University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Dr Sébastien Deferm, Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Limburg, Belgium; sebastien.deferm{at}


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.

  • cardiac surgical procedures
  • atrial fibrillation
  • mitral valve insufficiency

Data availability statement

Individual deidentified participant data are not available. The study protocol and delineation of study cohorts can be shared on reasonable request.

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Data availability statement

Individual deidentified participant data are not available. The study protocol and delineation of study cohorts can be shared on reasonable request.

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  • PMV and FR are joint senior authors.

  • Twitter @S_Deferm, @Ph_Bertrand, @JeroenDauw, @alexvdbruaene, @pietvandervoort, @RegaFilip

  • Contributors All authors have made substantial contributions to the conception of this work, data analysis and content revision. The manuscript has been finally approved by all authors, who agree to be accountable for all aspects of the current work, in line with current ICMJE recommendations.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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