Key result
Isolated AVR stabilizes or improves functional mitral regurgitation in ~86% of patients without impacting survival.
Why the study?
Whether to address functional mitral regurgitation at the time of aortic valve replacement for severe aortic stenosis remains unclear.
Does isolated aortic valve replacement stabilize or improve functional mitral regurgitation in patients with severe aortic stenosis?
Observational (n=74)
No
Does isolated aortic valve replacement stabilize or improve functional mitral regurgitation in patients with severe aortic stenosis?
Isolated aortic valve replacement in patients with severe aortic stenosis and functional mitral regurgitation results in stable or improved MR in most patients, suggesting concurrent mitral valve surgery may be safely avoided in selected cases.
Isolated AVR appears adequate for mild-moderate FMR; leaves open whether concomitant mitral intervention benefits higher-risk subgroups.
BACKGROUND: Patients with aortic stenosis (AS) treated with aortic valve replacement (AVR) may also present with associated functional mitral valve regurgitation (FMR). Whether to also address the mitral valve at the time of AVR remains unclear. This study was designed to determine the influence of MR on survival and its evolution over time. METHODS: We retrospectively reviewed 74 patients with FMR who underwent isolated AVR between 1999 and 2006 at our institution. Inclusion criteria were surgery for AVR with severe AS (mean age, 69 years; N = 47; 64% women) and FMR (grade I, 80%; grade II, 19%; grade III, 1%). Echocardiography follow-up data were obtained by mail questionnaires sent to the referring cardiologists of all survivors. All parameters were analyzed with the Kaplan-Meier method and the sign test. RESULTS: The operative mortality rate was 2%, and 9 patients (12%) died during follow-up. The mean (SD) follow-up time was 48 ± 33 months, and follow-up 96% complete. The follow-up demonstrated a decrease of FMR by 2 degrees in 3 patients (4%), and 1 degree in 14 patients (19%); regurgitation remained unchanged in the majority of patients (n = 47; 63%). FMR worsened in 10 patients overall (14%), and new-onset atrial fibrillation was found in 24 patients (33%); however, the statistical analysis failed to demonstrate an impact of worsening FMR on survival. CONCLUSION: MR in patients with severe AS and FMR at the time of AVR does not appear to worsen significantly over time. Not dealing with the mitral valve at the time of AVR might be warranted for selected patients.
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Wyler et al. (2013) conducted an observational in Aortic stenosis with functional mitral regurgitation (n=74). Isolated aortic valve replacement was evaluated on Evolution of functional mitral regurgitation and survival. Following isolated aortic valve replacement for severe aortic stenosis, functional mitral regurgitation remained unchanged or improved in 86% of patients and did not significantly impact survival.