Surgical Techniques and Outcomes for Atrial Functional Mitral Regurgitation: Insights From the Mini Mitral International Registry
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Evidence on optimal therapeutic strategies for atrial functional mitral regurgitation (AFMR) remains limited. This study aimed to evaluate patient characteristics, surgical techniques, and outcomes in AFMR patients from the Mini Mitral International Registry (MMIR). METHODS: Patients undergoing mini mitral surgery for AFMR between 2015 and 2023 were identified. Exclusion criteria included organic lesions, abnormal leaflet motion, reduced left ventricular function, absence of annular dilation, and previous mitral procedures. RESULTS: Of 7957 patients, 430 (5.4%) met AFMR criteria. The cohort was elderly (median age 73), predominantly female (67.7%), with frequent atrial fibrillation (AF) (69.7%). Mitral repair was performed in 91.4% of patients, all via isolated annuloplasty except 3. Complete rings were used in 97.1%. On multivariable analysis, anterior mitral leaflet (AML) pseudo-prolapse was associated with an increased likelihood of valve replacement (OR 5.3, 95% CI 1.07-9.12). Concomitant tricuspid repair, AF ablation, and left atrial appendage closure were performed in 44.2%, 40.5%, and 25.6%, respectively. At discharge, 99% had none or mild regurgitation; in-hospital mortality and stroke were 2.3% and 1.9%. CONCLUSIONS: Findings from the MMIR indicate that mitral repair with isolated annuloplasty was the preferred surgical strategy for AFMR, providing satisfactory procedural and early clinical outcomes. The presence of AML pseudo-prolapse reduced the likelihood of valve repair. Overall operative results were favourable, with 99% of patients experiencing no or mild residual mitral regurgitation. These findings may serve as a reference for clinical decision-making in AFMR treatment pathways.
Authors: Paolo Berretta, Masaki Nakamura, Antonio Fiore, Joseph Lamelas, Nikolaos Bonaros, Jörg Kempfert, Loris Salvador, Marc Gerdisch, Frank Van Praet, Antonios Pitsis, Tristan Yan, Pietro G Malvindi, Pierluigi Stefano, Manuel Wilbring, Torsten Doenst, Davide Pacini, Nguyen Hoang Dinh, Mauro Rinaldi, Tom C Nguyen, Marco Di Eusanio
Institutions: Marche Polytechnic University, Baptist Hospital of Miami, Université Paris Cité, Hôpitaux Universitaires Henri-Mondor, University of Miami, Innsbruck Medical University, Universität Innsbruck, Deutsches Herzzentrum der Charité, Ospedale San Bortolo, Franciscan Health Indianapolis, Onze Lieve Vrouwziekenhuis Hospital, Interbalkan Medical Center, Royal Prince Alfred Hospital, Azienda Ospedaliero-Universitaria Careggi, Herzzentrum Dresden Universitätsklinik, Jena University Hospital, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, University of Medicine and Pharmacy at Ho Chi Minh City, University of Turin
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4416975669