Iung, B I

Abstract Background Mitral regurgitation (MR) is the most common heart valve disorder worldwide. The contrast between the large burden of MR and the overall low number of performed mitral valve surgery suggest a marked undertreatment of MR patients. Large and comprehensive contemporary data assessing the management and outcome of patients with MR as well as the societal burden of the disease at the Nationwide level are currently lacking. Methods Based on a French mandatory administrative hospital-discharge database, we collected all admissions in France both in public and private hospitals in 2014 and 2015 with MR as primary or secondary code. Patients with infective endocarditis, congenital or rheumatic disease were excluded. Cost were calculated for patients admitted in public hospitals. Results In 2014–2015, 107,412 patients with MR were admitted in France in 1238 public and private hospitals; 74,098 patients (69%) presented with primary MR (PMR) and 33,314 patients (31%) with secondary MR (SMR). Overall 8,676 patients (8%) were operated on (81% PMR) within 1 year and 98,736 (92%) were conservatively managed and constituted our study population. Mean age was 77±15 years (50% were ≥80 years and 12% ≥90 years) and 53% were female. Most of the patients presented with comorbidities and Charlson Index was ≥2 in 53% of the population. In-hospital and one-year mortality were 4.1% and 14.3% respectively. Readmission were very common and one-year mortality/readmission all cause, and one-year mortality / CHF readmission rates were 67% and 34% respectively and increased with age, Charlson Index, CHF at presentation and SMR etiology but events rate remained notably high in the PMR subset (64% and 28% respectively). The total annual cost in public hospitals (initial hospitalisation and readmissions) was 325,716,311 euros. When only readmissions for heart failure were considered (43% of all readmissions), total annual cost was 202,904,869 euros. Conclusion In this large administrative contemporary nationwide database, 1) MR was a common reason for admission and affected an elderly population with frequent comorbidities, 2) less than 10% of patients were offered any intervention, 3) MR was associated with high mortality and readmissions rates in all subsets; 4) MR represented a major societal burden with an extrapolated annual cost between 250 and 400 million euros. These finding highlight the critical need to develop strategies to improve the overall management and outcomes of patients with both primary and secondary MR. Acknowledgement/Funding Edwards Lifesciences

Abstract Background Contemporary and unbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the Nationwide level are scarce. The PMSI, a mandatory administrative database, offers the unique opportunity to assess the presentation and outcomes of all consecutive mitral valve (MV) surgeries performed in France in the contemporary era. Methods We collected all (isolated or combined) MV surgeries performed for MR in France both in public and private hospitals between 2014 and 2016. Based on an algorithm we developed, MR etiology was classified as degenerative (DMR), secondary (SMR) or OTHER (rheumatic, congenital, infective endocarditis or unknown). Results Between January 2014 and December 2016, 18,167 mitral valve surgeries were performed in France (55% repair and 45% replacement; 52% isolated MV surgery). Mean age was 66±12 years and 59% were male. Etiology was DMR in 42%, SMR in 16% and OTHER in 42%. Among DMR, repair rate was 68% overall and 72% in the subset who underwent an isolated MV surgery (70% of all DMR). Repair rates decreased with age, Charlson index and sex (female) (all P<0.0001). Among SMR, a repair was performed in 39% and a combined surgery in 51%. In-hospital mortality and rate of death / readmission for CHF at one year were 3.4% and 13% respectively for DMR (2.4% and 5.5% respectively for isolated DMR) and 7.8% and 17.8% respectively for SMR (5.5% and 12.4% respectively for isolated SMR). Center volume was associated with a lower in-hospital mortality (p=0.002) but not with higher DMR repair rate (P=0.85). Conclusion In this large administrative contemporary nationwide database, 1) DMR surgery was twice as frequent as SMR and more frequently performed isolated; 2) Repair rates in DMR were suboptimal overall but more critically in the elderly and women subsets. 3) Operative mortality and one-year rate of death and readmission were approximately twice as high in SMR than in DMR and overall considerable even for isolated DMR surgery; and 4) In DMR, center volume had no impact on repair rate but an independent impact on outcome. These results underline the need to develop strategies to improve management and outcomes of patients with both degenerative and secondary MR.