Prevalence, Aetiology, and Progression of Mitral Valve Regurgitation in Patients Diagnosed with Ascending Aortic Aneurysm

Mitral valve regurgitation (MR) may coexist or develop in patients with ascending aortic aneurysm (AscAA) due to shared pathophysiological mechanisms, including connective tissue disease, chronic aortic regurgitation (AR), and left ventricular (LV) remodelling.1–3 While concomitant mitral valve (MV) surgery is recommended in the presence of severe MR,4 the prevalence, progression, and clinical relevance of MR in the broader AscAA population remain poorly defined. In particular, the course of various forms of MR (primary/secondary), when not addressed simultaneously during aortic surgery, remains incompletely researched. Furthermore, it remains unclear whether MR in AscAA patients requires more intensive clinical attention. We therefore evaluated the prevalence, aetiology, and progression of MR in a large multicentre cohort of patients diagnosed with AscAA, with specific focus on MR before and after aortic aneurysm surgery. We performed a retrospective cohort study including adult patients diagnosed with an AscAA (aortic root and/or ascending aorta ≥40 mm on imaging) between 2007 and 2022 in two tertiary centres. Patients were required to have echocardiographic assessment of MR at AscAA diagnosis and no history of prior MV surgery (Figure 1A). Follow-up started at the time of AscAA diagnosis and ended at death, last follow-up or at aortic dissection/rupture. Details about the current database were previously published.5