Does moderate mitral regurgitation impact early or mid-term clinical outcome in patients undergoing isolated aortic valve replacement for aortic stenosis?
OBJECTIVE
The early and mid-term impact of functional mitral regurgitation (MR) in patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis remains unresolved.


METHODS
Through our institutional databank, using a case-match study, we identified 58 patients with MR grades 0-1 and 58 patients with MR grades 2-3 (patients matched for sex, age, ejection fraction (EF), NYHA, diabetes, and CVA). Data were collected prospectively (mean duration of follow-up: 3.2 +/- 2.4 years).


RESULTS
Perioperative morbidity (re-operation for bleeding, low cardiac output, CVA, renal failure) was comparable among groups. Difference in mortality between the two groups was non-significant (7.0 vs. 3.5%, P = 0.67 in groups MR 2-3 vs. 0-1, respectively). At early echocardiographic follow-up, 7/58 patients (12.1%) within group MR grades 0-1 increased their MR to grades 2-3; among which only two remained with MR grades 2-3 at mid-term follow-up. Within MR group 2-3, 18/58 (31.0%) remained with MR grades 2-3 among which 7/18 (38.9%) decreased of at least one grade at follow-up. Eight year actuarial survival was comparable in both groups: MR grades 0-1 = 60.9% vs. MR grades 2-3 = 55.0%; P = 0.1. Actuarial survival of patients with MR grades 2-3 postoperatively was similar to patients with MR grades 0-1 (MR grades 0-1 = 59.0%, MR grades 2-3 = 58.9%, P = NS).


CONCLUSIONS
Presence of preoperative moderate functional MR (grades 2-3) in patients undergoing isolated AVR for aortic stenosis regresses in the majority of patients postoperatively and has no significant impact on perioperative morbidity or mortality, nor mid-term survival. Thus, moderate functional MR should be treated conservatively in the majority of patients especially in the elderly subjected to isolated AVR for aortic stenosis.
Absil
B
B
Department of Cardiovascular Surgery, Québec Heart Institute, Laval Hospital, Laval University, 2725 chemin Sainte-Foy, Sainte-Foy, Canada G1V 4G5.
Dagenais
F
F
Mathieu
P
P
Métras
J
J
Perron
J
J
Baillot
R
R
Bauset
R
R
Doyle
D
D
D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D016022:Case-Control Studies; D018572:Disease-Free Survival; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D015996:Survival Rate