Impact of concomitant mitral valve surgery on the clinical outcomes of patients with moderate functional mitral regurgitation and HFpEF undergoing aortic valve replacement: a cohort study

Q: What are the key findings of this study?

Aortic valve replacement with concomitant mitral valve surgery increased the risk of overall mortality to 10% compared to 0% in isolated aortic valve replacement in patients with moderate functional mitral regurgitation and HFpEF.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Moderate functional mitral regurgitation and HFpEF (n=212). Intervention: Aortic valve replacement with concomitant mitral valve surgery (AVR-MVS) vs. Isolated aortic valve replacement (AVR). Primary outcome: Overall mortality (HR 4.39, 95% CI 1.43–16.23, p=<0.001).

Q: What does this research mean for the field?

Aortic valve replacement with concomitant mitral valve surgery increased the risk of overall mortality to 10% compared to 0% in isolated aortic valve replacement in patients with moderate functional mitral regurgitation and HFpEF. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Xieraili Tiemuerniyazi; Ziang Yang; Yifeng Nan; Yangwu Song; Wei Zhao; Fei Xu; Wei Feng

doi:10.1186/s13019-023-02197-2

April 5, 2023Journal of Cardiothoracic SurgeryOpen Access

Impact of concomitant mitral valve surgery on the clinical outcomes of patients with moderate functional mitral regurgitation and HFpEF undergoing aortic valve replacement: a cohort study

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Key result

AVR with concomitant MVS is linked to ~339% higher mortality versus isolated AVR in HFpEF.

HR 4.39
95% CI 1.43–16.23
P<0.001
n=212

Figures

Why the study?

While concomitant mitral valve surgery is recommended for severe functional mitral regurgitation during aortic valve replacement, the optimal management of moderate functional mitral regurgitation in patients with HFpEF remains unclear.

Does concomitant mitral valve surgery improve overall mortality in patients with moderate functional mitral regurgitation and HFpEF undergoing aortic valve replacement?

Study Design

Type

Cohort (n=212)

Structured PICO

Does concomitant mitral valve surgery improve overall mortality in patients with moderate functional mitral regurgitation and HFpEF undergoing aortic valve replacement?

P

Population

212 adults (>18 years) with severe aortic valve disease complicated with moderate functional mitral regurgitation (FMR) and HFpEF (EF ≥50%, NT-proBNP >125 pg/mL), mean age 58.9, 27.8% female.

I

Intervention

Concomitant mitral valve surgery (AVR-MVS) (repair or replacement) during aortic valve replacement

C

Comparator

Isolated aortic valve replacement (AVR)

O

Outcome

Overall mortalityhard clinical

Main Result

Effect estimate: HR 4.39 (95% CI 1.43–16.23)

Absolute Event Rate: 10% vs 0%

p-value: p=<0.001

Limitations

Retrospective study design
Limited sample size
Potential bias from surgeon's judgment and preference
Unmeasured confounders
Follow-up echocardiographic results not available for all patients
Retrospective study design with potential observational bias
Limited sample size restricting the power of tests
Surgeons' judgement and preference might have caused bias
Unmeasured confounders may still exist despite IPTW analysis
Follow-up echocardiographic results were not available for all surviving patients

Implication

In patients with moderate functional mitral regurgitation and HFpEF undergoing aortic valve replacement, concomitant mitral valve surgery increases mortality compared to isolated aortic valve replacement.

Abstract

Background Functional mitral regurgitation (FMR) worsens the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). While concomitant mitral valve surgery (MVS) is recommended for severe FMR during aortic valve replacement (AVR), the optimal treatment of moderate FMR, especially in those with HFpEF, remains unclear. This study aimed to evaluate the effect of MVS in patients with moderate FMR and HFpEF undergoing AVR. Methods A total of 212 consecutive patients (AVR: 34.0%, AVR-MVS: 66.0%) during 2010 and 2019 were enrolled. Survival outcomes were compared. Inverse probability treatment weighting (IPTW) was used to balance the baseline characteristics. Kaplan-Meier curve and log-rank test were applied to compare the survival outcomes. The primary endpoint was the overall mortality. Results The mean age was 58.9 ± ± 11.9 years, and 27.8% of them were female. During a median follow-up of 16.4 months, AVR-MVS did not reduce the risk of mid-term MACCE (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 0.57–4.17, P log-rank = 0.396), while it showed a tendency toward higher MACCE risk in the IPTW analysis (HR: 2.62, 95% CI: 0.84–8.16, P log-rank = 0.096). In addition, AVR-MVS increased the risk of mortality as compared to isolated AVR (0 vs. 10%, P log-rank = 0.016), which was sustained in the IPTW analysis (0 vs. 9.9%, P log-rank <0.001). Conclusion In patients with moderate FMR and HFpEF, isolated AVR might be more reasonable than AVR-MVS.

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Cite This Study

Tiemuerniyazi et al. (2023) conducted a cohort in Moderate functional mitral regurgitation and HFpEF (n=212). Aortic valve replacement with concomitant mitral valve surgery (AVR-MVS) vs. Isolated aortic valve replacement (AVR) was evaluated on Overall mortality (HR 4.39, 95% CI 1.43–16.23, p=<0.001). Aortic valve replacement with concomitant mitral valve surgery increased the risk of overall mortality to 10% compared to 0% in isolated aortic valve replacement in patients with moderate functional mitral regurgitation and HFpEF.

synapsesocial.com/papers/69692ad012fd9cb588971dbe https://doi.org/10.1186/s13019-023-02197-2