Clinical outcomes and management strategies for moderate aortic regurgitation in patients undergoing rheumatic mitral valve surgery

Additional exploration is required to determine how to treat patients with moderate aortic regurgitation (AR) in rheumatic mitral valve (MV) surgery. This study compared clinical outcomes in patients undergoing non-surgical treatment (NT) of aortic valve (AV), aortic valvuloplasty (AVP), and aortic valve replacement (AVR). This multicenter, retrospective observational cohort study included 338 moderate AR patients undergoing rheumatic MV surgery from January 2015 to January 2024. We followed up with patients for a median of 43.4 months. Furthermore, more-than-mild aortic valve dysfunction (AVD) in the follow-up period was our primary outcome. Our secondary outcomes were all-cause mortality and cardiac valve reoperation before discharge and during follow-up. We classified patients into three groups, namely, NT (n = 128), AVP (n = 91), and AVR (n = 119) groups, respectively. Moreover, 33.0%, 30.1%, and 3.9% of patients achieved our primary outcome, while 4.2%, 5.6%, and 9.6% of them attained our secondary outcomes in the three groups, respectively. We observed that fewer patients from the AVR group had achieved the primary outcome than those in the NT adjusted relative risk (RR), 0.41; 95% confidence interval (CI), 0.21-0.68; p = 0.002 and AVP groups (adjusted RR, 0.14; 95% CI, 0.04-0.43; p = 0.002), respectively. The secondary outcomes did not significantly differ among the three groups. Without increasing surgical risks, the concurrent AVR significantly improves AV status in moderate AR patients undergoing rheumatic MV surgery throughout follow-up. None or mild AVD was observed in many patients from the NT group during the follow-up, thereby warranting the delay of surgery for AV.