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Messika-Zeitoun D, Candolfi P, Dreyfus J, Burwash IG, Iung B, Philippon JF, Toussaint JM, Verta P, Feldman TE, Obadia JF, Vahanian A, Mesana T, Enriquez-Sarano M. Management and Outcome of Patients Admitted With Tricuspid Regurgitation in France. Can J Cardiol 2020; 37:1078-1085. [PMID: 33358751 DOI: 10.1016/j.cjca.2020.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Growing evidence shows a major outcome impact and undertreatment of tricuspid regurgitation (TR), but large and comprehensive contemporary reports of management and outcome at the nationwide level are lacking. METHODS We gathered all consecutive patients admitted with a diagnosis of likely functional TR in 2014-2015 in France from the Programme de Médicalisation des Systèmes d'Information national database and collected rate of surgery, in-hospital mortality, 1-year mortality, or heart failure (HF) readmission rates. RESULTS In 2014-2015, 17,676 consecutive patients (75 ± 14 years of age, 51% female) were admitted with a TR diagnosis. Charlson index was ≥ 2 in 56% of the population and 46% presented with HF. TR was associated with prior cardiac surgery, ischemic/dilated cardiomyopathy, or mitral regurgitation in 73% of patients. Only 10% of TR patients overall and 67% of those undergoing mitral valve surgery received a tricuspid valve intervention. Among the 13,654 (77%) conservatively managed patients, in-hospital mortality, 1-year mortality, and 1-year mortality or HF readmission rates were 5.1%, 17.8%, and 41%, respectively, overall, and 5.3%,17.2%, and 37%, respectively, among those with no underlying medical conditions (8-fold higher than predicted for age and gender). CONCLUSIONS This nationwide cohort of patients admitted with TR included elderly patients with frequent comorbidities/underlying cardiac diseases. In patients conservatively managed, mortality and morbidity were considerably high over a short time span. Despite this poor prognosis, only 10% of patients underwent a tricuspid valve intervention. These nationwide data showing a considerable risk and potential underuse of treatment highlight the critical need to develop strategies to improve the management and outcomes of TR patients.
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Affiliation(s)
| | | | | | - Ian G Burwash
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Bernard Iung
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; Faculté de Médecine Paris-Diderot, University Paris VII, Paris, France
| | - Jean-François Philippon
- Département d'épidémiologie et de biostatistiques, Ecole des hautes études en santé publique, Paris, France
| | | | | | | | - Jean-Francois Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Alec Vahanian
- INSERM U1148, Bichat Hospital, Paris, France; Faculté de Médecine Paris-Diderot, University Paris VII, Paris, France
| | - Thierry Mesana
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Disease, Mayo Clinic and Mayo Medical School, Rochester, Minnesota, USA
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Messika-Zeitoun D, Candolfi P, Enriquez-Sarano M, Burwash IG, Chan V, Philippon JF, Toussaint JM, Verta P, Feldman TE, Iung B, Glineur D, Obadia JF, Vahanian A, Mesana T. Presentation and outcomes of mitral valve surgery in France in the recent era: a nationwide perspective. Open Heart 2020; 7:openhrt-2020-001339. [PMID: 32788294 PMCID: PMC7422639 DOI: 10.1136/openhrt-2020-001339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives Unbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the nationwide level are scarce and mainly US-based. The Programme de Médicalisation des Systèmes d’Information, a mandatory national 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 MV surgeries performed for MR in France in 2014–2016. MR aetiology was classified as degenerative (DMR), secondary (SMR) or Other (rheumatic or congenital disease and infective endocarditis). Results During the 3-year period, 18 167 MV surgeries were performed in France (55% repair and 45% replacement; 52% isolated). Age was 66±12 years and 59% were male. Aetiology was DMR in 42%, SMR in 16% and other in 42% including 19% with uncertain aetiologies. Overall, in-hospital mortality was 6.5% and increased with age, female gender, Charlson Comorbidity Index, type of surgery (replacement vs repair), associated surgery (combined vs isolated) and MR aetiology (all p<0.01). In-hospital mortality and rate of death/readmission for heart failure (HF) at 1 year were 3.4% and 13%, respectively for DMR (2.4% and 11% for isolated DMR) and 7.8% and 27%, respectively for SMR (5.5% and 23% for isolated SMR). Repair rate was 55% overall, 68% in DMR and 72% for isolated DMR surgery (70% of all DMR). Repair rates decreased with age, Charlson Comorbidity Index and female sex (all p<0.0001). Conclusion In this cross-sectional contemporary prospective nationwide database, in-hospital mortality and 1 year rate of death and HF readmission were considerable overall and in all subsets. Repair rates were suboptimal overall especially in the elderly and women subsets. These results underline the need to develop strategies to improve management and outcomes of patients with both DMR and SMR.
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Affiliation(s)
| | | | | | - Ian G Burwash
- Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vincent Chan
- Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jean-Francois Philippon
- Département D'Epidémiologie et de Biostatistiques, Ecole des Hautes Études en Santé Publique, Paris, France
| | | | | | - Ted E Feldman
- Edwards Lifesciences, Irvine, California, United States
| | | | - David Glineur
- Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Alec Vahanian
- University Paris VII, Faculté de Médecine Paris-Diderot, Paris, France
| | - Thierry Mesana
- Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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