Outcomes of Moderate Aortic Regurgitation in Rheumatic Heart Disease Patients Undergoing Mitral Valve Replacement for Severe Mitral Stenosis

Background: The optimal management of pre-existing moderate aortic regurgitation (AR) that occurs in patients undergoing mitral valve surgery remains controversial, particularly regarding whether concomitant aortic valve intervention is warranted. This study aimed to evaluate the outcomes and fate of moderate aortic regurgitation in patients with rheumatic heart disease (RHD) undergoing isolated mitral valve replacement (MVR) for severe mitral stenosis (MS), without concomitant AVR. Methods: This retrospective cohort study was conducted at the Department of Cardiothoracic Surgery and the Department of Cardiology, National Heart Institute, GOTHI, on 80 patients with RHD presenting with severe MS and moderate AR, who underwent isolated MVR. Clinical and echocardiographic parameters were assessed preoperatively, intraoperatively, at discharge and at 24-months follow-up. Results: All AR severity metrics (vena contracta, jet ratio, regurgitant fraction) showed significant improvement at 24 months, along with significant reductions in left atrial diameter and left ventricular dimensions and retained LVEF. NYHA functional class significantly improved, with 95.0% of patients in class I–II at 24 months, while only 2 patients (2.5%) advanced to severe AR. 76.2% of patients had mechanical prosthesis, and mitral prosthetic valve function was satisfactory, with a mean transprosthetic gradient of 4.4 ± 1.3 mmHg and no prosthetic regurgitation in 91.2% of evaluated patients. Conclusion: In this retrospective single-center cohort, isolated MVR in appropriately selected patients with severe rheumatic mitral stenosis and moderate AR was associated with stability or regression of AR severity and favorable clinical and echocardiographic outcomes at 24 months of follow up.