{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T08:09:52Z","timestamp":1778573392647,"version":"3.51.4"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The progression of extra-mitral valve (MV) cardiac damage in patients with primary mitral regurgitation (MR) following surgical repair has not been described. We aimed to investigate the evolution of extra-MV cardiac damage after MV repair and to assess its prognostic significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with severe primary MR undergoing surgical repair at 5 referral centres were included when echocardiographic follow-up assessment was available. Based on echocardiographic parameters at baseline and at a median follow-up of 7 (interquartile range [IQR] 4-11) months after MV repair, patients were hierarchically classified as follows: stage 0: no cardiac damage; stage 1: left ventricular dilatation and\/or dysfunction; stage 2: left atrial dilatation and\/or atrial fibrillation; stage 3: pulmonary hypertension and\/or significant tricuspid regurgitation. The primary outcome was all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 764 patients (mean age 62\u2009\u00b1\u200913 years, 70% men) were included. Compared to baseline, 43% improved at least 1 stage, 49% remained unchanged, and 8% worsened at least 1 stage during follow-up after MV repair. At a median follow-up of 91 months after MV repair, 94 patients (12%) died. By multivariate Cox regression analysis, after adjusting for potential confounders, extra-MV cardiac damage staging at follow-up (HR per-1-stage-increase\u2009=\u20091.571; P\u2009=\u2009.009) and cardiac damage evolution (improved group, HR\u2009=\u20090.467; P\u2009=\u2009.034; worsened group, HR\u2009=\u20092.481, P\u2009=\u2009.037) were independently associated with all-cause mortality and had incremental prognostic value over preprocedural assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Extra-MV cardiac damage improves significantly after MV repair, and its evolution is independently associated with all-cause mortality, suggesting the importance of comparative echocardiographic assessment following MV repair to improve risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag149","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T11:44:13Z","timestamp":1775735053000},"source":"Crossref","is-referenced-by-count":0,"title":["Extent and Progression of Cardiac Damage in Patients With Primary Mitral Regurgitation Undergoing Surgical Repair"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-1777","authenticated-orcid":false,"given":"Rinchyenkhand","family":"Myagmardorj","sequence":"first","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden 2333 ZA,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6905-9439","authenticated-orcid":false,"given":"Federico","family":"Fortuni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden 2333 ZA,","place":["The Netherlands"]},{"name":"Cardiology and Cardiovascular Pathophysiology, S. Maria Della Misericordia Hospital, University of Perugia , Perugia 06129,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0696-1625","authenticated-orcid":false,"given":"Valentina","family":"Mantegazza","sequence":"additional","affiliation":[{"name":"Department of Peri-Operative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS , Milan 20138,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5636-8945","authenticated-orcid":false,"given":"Aniek L","family":"van Wijngaarden","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden 2333 ZA,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7280-8258","authenticated-orcid":false,"given":"Hoi 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