Key result
Isolated AVR for severe aortic stenosis led to mitral regurgitation disappearance in 56.2% and improvement in 15.6% by discharge, though pre-existing MR had higher mortality (5.2% vs 3.7%, p=0.025).
Why the study?
Mild-to-moderate mitral regurgitation often coexists with severe aortic stenosis, and concomitant double-valve replacement carries greater morbidity and mortality than isolated AVR. The clinical outcome of persistent MR after isolated AVR was uninvestigated, motivating an evaluation of postoperative changes in MR severity and predictors of improvement.
Cohort (n=149)
No
Observational cohort study shows functional mitral regurgitation improves following aortic valve replacement, indicating isolated repair resolves secondary leakage in most patients.
Objective: Mild-to-moderate mitral regurgitation (MR) often coexists with severe aortic stenosis and has been reported to be presented in up to 2/3 patients requiring aortic valve replacement (AVR). MR in patients with aortic stenosis is often functional in nature although organic mitral disease may coexist. Increased afterload and left ventricular remodeling have been implicated to explain the functional MR in patients with aortic valve stenosis. Furthermore, remodeling observed after AVR may impact the outcome of MR postoperatively. However, the clinical outcome of persistent MR after AVR is uninvestigated. On the other hand, concomitant replacement of the aortic and mitral valves is associated with an increased morbidity and mortality compared to an isolated AVR. This study aims to assess the change in MR severity following AVR for severe AS and to determine the factors associated with the MR improvement. Material and Methods: The clinical and surgical characteristics were compared in a cohort of 149 consecutive patients who underwent isolated AVR in Aleppo University Hospital for cardiac surgery. Results: Non-severe functional mitral valve regurgitation was detected prior to surgery in 25.5% of the patients. These patients were older (p = 0.007), more often had ventricular dysfunction (p = 0.02) and pulmonary hypertension (p = 0.04), and had been admitted more frequently for heart failure (0.008), with fewer of them conserving sinus rhythm (p = 0.003). In addition, the pre-surgery existence of MR was associated with greater morbidity and mortality (5.2% vs. 3.7%; p = 0.025). The MR disappeared or improved prior to hospital discharge in 56.2% and 15.6%, respectively. Independent factors predicting this improvement were the presence of coronary lesions (OR 3.74, p = 0.03), and the absence of diabetes (OR 0.28, p = 0.005) as well as pulmonary hypertension (OR 0.34, p = 0.01). Conclusion: In this study, MR decreased or disappeared in a high percentage of patients after AVR surgery. Independent factors predicting this improvement included the presence of prior coronary lesions, although the improvement is influenced by the diabetic status of the patient, as well as pulmonary hypertension.
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Aljadayel et al. (2015) conducted a cohort in Severe aortic stenosis with concomitant functional mitral regurgitation (n=149). Isolated aortic valve replacement (AVR) in patients with pre-existing non-severe functional mitral regurgitation vs. Patients undergoing isolated AVR without pre-existing mitral regurgitation was evaluated on Disappearance or improvement of mitral regurgitation prior to hospital discharge; in-hospital morbidity and mortality (p=0.025). Isolated AVR for severe aortic stenosis led to mitral regurgitation disappearance in 56.2% and improvement in 15.6% by discharge, though pre-existing MR had higher mortality (5.2% vs 3.7%, p=0.025).
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