Key result
Isolated AVR shows inconclusive trends toward improving moderate functional MR in aortic stenosis.
Why the study?
Functional mitral regurgitation is often associated with aortic stenosis and may resolve after aortic valve replacement, but evidence-based recommendations for concomitant surgery are lacking.
Does isolated AVR improve moderate functional MR in patients with aortic stenosis?
Systematic Review (n=2,113)
Does isolated AVR improve moderate functional MR in patients with aortic stenosis?
Current evidence is of poor quality and inconclusive regarding whether concomitant mitral valve surgery is indicated for moderate functional MR during AVR for AS.
Evidence remains inconclusive on MR improvement after isolated AVR; leaves open whether concomitant mitral surgery is warranted in moderate functional MR with AS.
BACKGROUND: Mitral regurgitation (MR) is associated with poor clinical outcomes. Functional MR is often associated with aortic stenosis (AS) and may resolve after aortic valve replacement (AVR). The objective of this study was to derive evidence-based recommendations regarding surgical intervention for moderate functional MR at the time of AVR for AS. METHODS: An exhaustive literature search strategy including Medline, Embase, the Cochrane library, and meeting abstracts was performed. Studies meeting inclusion criteria were critically appraised and data pooled according to accepted meta-analysis techniques. The primary outcome was change in moderate MR after isolated AVR. Secondary outcomes were the impact of functional MR on survival and identifying factors that predict progression of MR, in patients undergoing isolated AVR for AS. RESULTS: Thirteen nonrandomized studies including 2113 patients were reviewed. A total of 268 patients had preoperative moderate functional MR and AS. All studies were appraised as poor methodological quality. After isolated AVR a trend toward improvement in MR was observed. Left ventricular dysfunction, left atrial enlargement, and atrial fibrillation were associated with progression of MR after AVR. However, the impact of residual MR on late survival was not consistent. CONCLUSION: Pooling current evidence provided inconclusive evidence to make clinical practice recommendations for or against routine surgical intervention of moderate MR at the time of AVR for AS. The incidence of this pathology makes further clinical trial studies warranted.
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Alghamdi et al. (2009) conducted a systematic review in Aortic stenosis and moderate functional mitral regurgitation (n=2,113). Isolated aortic valve replacement was evaluated on Change in moderate MR after isolated AVR. Among 268 patients with moderate functional mitral regurgitation and aortic stenosis, isolated aortic valve replacement showed a trend toward improvement in MR, though evidence was inconclusive.
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