Key result
Mild aortic valve disease remains stable after mitral valve surgery, with preoperative lesions predicting progression.
Why the study?
Coexistent mild aortic valve disease is frequently observed in patients undergoing mitral valve surgery, but the clinical significance and progression of these lesions remain uncertain.
Cohort (n=80)
No
Odds Ratio: 0.038 (95% CI 0.002–0.948)
p-value: p=0.046
Mild aortic valve disease in patients undergoing mitral valve surgery generally remains stable over a mean follow-up of 3.5 years, supporting a conservative approach to the aortic valve during mitral surgery.
May support conservative aortic management during mitral surgery; leaves open need for prospective validation.
Background: Coexistent mild aortic valve disease is frequently observed in patients undergoing mitral valve surgery, yet the clinical significance and progression of these lesions remain uncertain. This study aimed to evaluate the progression and clinical outcomes of mild aortic valve disease following mitral valve surgery. Methods: This single-centre observational study included 80 patients who underwent primary mitral valve surgery with documented mild aortic valve disease. Patients were evaluated through a hybrid design, consisting of a retrospective cohort (n=43) from 2010 to 2017 and a prospective cohort (n=37) from 2016 to 2019, using echocardiographic and clinical assessments. Results: At baseline, out of the 80 patients, 82.5% (n=66) presented with aortic regurgitation (AR) lesions, which comprised isolated mild AR (n=53; 66.2%), trivial AR (n=4; 5%), moderate AR (n=4; 5%), and mixed mild AR with mild aortic stenosis (AS) (n=5; 6.2%). The remaining 17.5% (n=14) presented with isolated mild AS. Follow-up clinical and echocardiographic assessment was completed in 74 patients, while six patients were lost to follow-up. During follow-up (mean duration: 3.54±1.48 years), most assessed patients remained clinically and echocardiographically stable. Among patients with isolated mild AR at baseline, eight patients progressed to moderate AR, while the remaining patients did not demonstrate clinically meaningful progression. Pressure half-time decreased from 643.53±103.90 ms preoperatively to 592.30±120.55 ms postoperatively (t=5.122; p<0.001), and vena contracta increased from 0.26±0.05 cm to 0.31±0.10 cm (t=4.472; p<0.001), without clinically significant deterioration. In patients with aortic stenosis, the aortic valve area decreased from 1.66±0.04 cm² to 1.59±0.02 cm² (t=2.047; p=0.044), and the mean gradient increased from 16±1.73 mmHg to 19±1.00 mmHg (t=2.145; p=0.035). Kaplan-Meier analysis demonstrated an event-free survival rate of 94.6% at the final follow-up. Multivariate analysis identified preoperative aortic valve lesion as the only significant predictor of disease progression (OR: 0.038; 95% CI: 0.002-0.948; p=0.046). Conclusions: Mild aortic valve disease in patients undergoing mitral valve surgery generally remains stable and does not demonstrate significant clinical progression. Routine echocardiographic surveillance remains important to identify the minority of patients who may develop progressive valve dysfunction.
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Durbesula et al. (2026) conducted a cohort in Coexistent mild aortic valve disease (n=80). Mitral valve surgery was evaluated on Progression of aortic valve disease (OR 0.038, 95% CI 0.002-0.948, p=0.046). In patients undergoing mitral valve surgery, coexistent mild aortic valve disease generally remained stable, with preoperative aortic valve lesion being the only significant predictor of progression (OR 0.038).
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