{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:29:56Z","timestamp":1790800196233,"version":"4.1.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000860","name":"European Society of Cardiology","doi-asserted-by":"crossref","award":["App000080404"],"award-info":[{"award-number":["App000080404"]}],"id":[{"id":"10.13039\/501100000860","id-type":"DOI","asserted-by":"crossref"}]},{"name":"French Ministry of Health"},{"DOI":"10.13039\/501100003100","name":"F\u00e9d\u00e9ration Fran\u00e7aise de Cardiologie","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003100","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Fondation C\u0153ur et Recherche"},{"name":"University of Nantes Department of Cardiology"},{"DOI":"10.13039\/100007048","name":"Mayo Foundation for Medical Education and Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007048","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Indications for surgery in patients with degenerative mitral regurgitation (DMR) are increasingly liberal in all clinical guidelines but the role of secondary outcome determinants (left atrial volume index \u226560 mL\/m2, atrial fibrillation, pulmonary artery systolic pressure \u226550 mmHg and moderate to severe tricuspid regurgitation) and their impact on post-operative outcome remain disputed. Whether these secondary outcome markers are just reflective of the DMR severity or intrinsically affect survival after DMR surgery is uncertain and may have critical importance in the management of patients with DMR. To address these gaps of knowledge the present study gathered a large cohort of patients with quantified DMR, accounted for the number of secondary outcome markers and examined their independent impact on survival after surgical correction of the DMR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>The Mitral Regurgitation International DAtabase-Quantitative registry includes patients with isolated DMR from centres across North America, Europe, and the Middle East. Patient enrolment extended from January 2003 to January 2020. All patients undergoing mitral valve surgery within 1 year of registry enrolment were selected. A total of 2276 patients [65 (55\u201373) years, 32% male] across five centres met study eligibility criteria. Over a median follow-up of 5.6 (3.6 to 8.7) years, 278 patients (12.2%) died. In a comprehensive multivariable Cox regression model adjusted for age, EuroSCORE II, symptoms, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LV ESD) and DMR severity, the number of secondary outcome determinants was independently associated with post-operative all-cause mortality, with adjusted hazard ratios of 1.56 [95% confidence interval (CI): 1.11\u20132.20, P = 0.011], 1.78 (95% CI: 1.23\u20132.58, P = 0.002) and 2.58 (95% CI: 1.73\u20133.83, P &amp;lt; 0.0001) for patients with one, two, and three or four secondary outcome determinants, respectively. A model incorporating the number of secondary outcome determinants demonstrated a higher C-index and was significantly more concordant with post-operative mortality than models incorporating traditional Class I indications alone [the presence of symptoms (P = 0.0003), or LVEF \u226460% (P = 0.006), or LV ESD \u226540 mm (P = 0.014)], while there was no significant difference in concordance observed compared with a model that incorporated the number of Class I indications for surgery combined (P = 0.71).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large cohort of patients treated surgically for DMR, the presence and number of secondary outcome determinants was independently associated with post-surgical survival and demonstrated better outcome discrimination than traditional Class I indications for surgery. Randomised controlled trials are needed to determine if patients with severe DMR who demonstrate a cardiac phenotype with an increasing number of secondary outcome determinants would benefit from earlier surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad004","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T16:09:58Z","timestamp":1672848598000},"page":"871-881","source":"Crossref","is-referenced-by-count":41,"title":["Factors influencing post-surgical survival in degenerative mitral regurgitation"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8258-8802","authenticated-orcid":false,"given":"Steele C","family":"Butcher","sequence":"first","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden , Netherlands"},{"name":"Department of Cardiology, Royal Perth Hospital , Victoria Square, Perth WA 6000 , 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