Key result
Omitting concurrent aortic surgery during rheumatic mitral surgery is linked to ~198% greater AV dysfunction risk.
Why the study?
Does concurrent aortic valvuloplasty or replacement prevent more-than-mild aortic valve dysfunction in patients undergoing rheumatic mitral valve surgery with moderate aortic valve dysfunction?
Cohort (n=343)
Does concurrent aortic valvuloplasty or replacement prevent more-than-mild aortic valve dysfunction in patients undergoing rheumatic mitral valve surgery with moderate aortic valve dysfunction?
Relative Risk: 2.98 (95% CI 1.61–5.62)
Absolute Event Rate: 27.9% vs 8%
p-value: p=<0.001
Concomitant aortic valve surgery during rheumatic mitral valve surgery significantly reduces subsequent aortic valve dysfunction, though delaying AV surgery may be safe for those with predominant moderate aortic regurgitation.
May support concomitant aortic intervention in rheumatic mitral surgery with moderate aortic disease; leaves open randomized confirmation before practice change.
Background: There are insufficient data regarding how to deal with moderate aortic valve (AV) dysfunction during rheumatic mitral valve (MV) surgery. In this study, the clinical outcomes of patients who underwent rheumatic MV surgery with or without concurrent AV procedures were compared. Methods: A total of 343 patients who underwent rheumatic MV surgery with moderate AV dysfunction were enrolled between January 2015 and August 2022, and a median 40-month follow-up was conducted. The more-than-mild AV dysfunction during follow-up was the primary endpoint event, while all-cause mortality and cardiac reoperation both before discharge and during follow-up encompassed the secondary endpoint events. Results: Patients were allocated into two groups, including the no treatment (NT) (n=121) and aortic valvuloplasty (AVP) or aortic valve replacement (AVR) groups (n=222). Most of patients (110/121, 90.9%) in the NT group were combined with predominant aortic regurgitation. In the NT and AVP or AVR groups, 27.9% and 8.0% of patients reached the primary endpoint, and 5.0% and 7.3% of patients experienced the secondary endpoint events, respectively. This study confirmed a significantly higher proportion of patients in the NT group who reached the primary endpoint (relative risk, 2.98; 95% confidence interval: 1.61-5.62; P<0.001), after inverse probability treatment weighting. Conclusions: Concomitant AV surgery significantly improved AV condition during follow-up for patients with moderate AV dysfunction during rheumatic valve surgery. However, it was safe and reasonable to delay surgical treatment of the AV and regular follow-ups for patients with predominant moderate aortic regurgitation.
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Liu et al. (2025) conducted a cohort in Moderate aortic valve dysfunction during rheumatic mitral valve surgery (n=343). No treatment of moderate aortic valve dysfunction vs. Aortic valvuloplasty or aortic valve replacement was evaluated on More-than-mild aortic valve dysfunction during follow-up (RR 2.98, 95% CI 1.61-5.62, p=<0.001). Omitting concurrent aortic valve surgery during rheumatic mitral valve surgery increased the risk of more-than-mild AV dysfunction during follow-up (RR 2.98; 95% CI 1.61-5.62; P<0.001).
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