In patients undergoing isolated surgical aortic valve replacement, preoperative moderate mitral regurgitation was strongly associated with postoperative significant mitral regurgitation at 1 year (OR 11.9).
Observational (n=430)
Yes
What are the risk factors for postoperative significant MR in patients with severe aortic stenosis and untreated mild-to-moderate MR undergoing isolated surgical AVR?
In patients undergoing isolated surgical AVR, preoperative moderate MR, larger left atrial dimension, and lower aortic velocity predict persistent or worsening MR and worse clinical outcomes.
Odds Ratio: 11.9 (95% CI 3.8–38.5)
p-value: p=<.001
Background Postoperative persistent/worsening mitral regurgitation (MR) is reported to be a prognostic marker in patients undergoing isolated aortic valve replacement (AVR). However, there is little evidence regarding the surgical indication for coexisting mild-to-moderate MR in patients undergoing isolated surgical AVR. This study evaluates the relationship between untreated mild-to-moderate MR and postoperative significant MR after surgical AVR. Methods Between 2016 and 2021, 430 patients with severe aortic stenosis underwent isolated surgical AVR with untreated mild-to-moderate MR. The primary endpoint was significant (moderate or greater) MR at 1 year after surgery. Composite endpoint (mortality and heart failure readmission) was also retrospectively reviewed. The mean follow-up duration was 5.0 ± 2.0 years. Results At 1 year after surgery, 22 patients (5%) presented with moderate or greater MR. Multivariable analysis showed aortic valve peak velocity (OR, 0.44; 95% CI, 0.22–0.89; P= .021), moderate MR (OR, 11.9; 95% CI, 3.80–38.5; P = < 0.001), and left atrial dimension index (OR, 1.12; 95% CI, 1.02–1.25; P= .020) at baseline were risk factors for postoperative significant MR. The freedom from composite endpoint were significantly lower in patients with multiple risk factors for MR than those without (log-rank P= .041). Conclusions In patients undergoing isolated surgical AVR with untreated mild-to-moderate MR, preoperative aortic velocity, left atrial dimension, and moderate MR were associated with postoperative significant MR, as well as increased heart failure readmission rates. These risk factors need to be considered in coexisting mild-to-moderate MR when treating aortic valvular lesion. Clinical registration number Approved by the Clinical Research Ethics Committee of Osaka University Hospital: Approval No.: 20,222 (T2).
Misumi et al. (Wed,) conducted a observational in Severe aortic valve stenosis with untreated mild-to-moderate mitral regurgitation (n=430). Preoperative moderate mitral regurgitation vs. Preoperative mild mitral regurgitation was evaluated on Significant (moderate or greater) mitral regurgitation at 1 year after surgery (OR 11.9, 95% CI 3.80-38.5, p=<.001). In patients undergoing isolated surgical aortic valve replacement, preoperative moderate mitral regurgitation was strongly associated with postoperative significant mitral regurgitation at 1 year (OR 11.9).