title: Incidence, associated factors and evolution of non-severe functional mitral regurgitation in patients with severe aortic stenosis undergoing aortic valve replacement.
abstract: BACKGROUND
  In order to improve the prognosis, repair of severe mitral regurgitation should be undertaken at the same time as aortic valve replacement in patients with severe aortic valve stenosis. However, mitral regurgitation may be secondary to pressure overload or ventricular dysfunction and improve after surgery.
  
  
  OBJECTIVE
  To assess the incidence of non-severe functional mitral regurgitation before and after isolated aortic valve replacement and determine its influence on the postoperative course.
  
  
  METHODS
  The clinical and surgical characteristics were compared in a cohort of 577 consecutive patients who underwent isolated aortic valve replacement.
  
  
  RESULTS
  The mean age was 68.4+/-9.2 years (44% women). Non-severe functional mitral valve regurgitation was detected prior to surgery in 26.5% of the patients. These patients were older (p=0.009), more often had ventricular dysfunction (p=0.005) and pulmonary hypertension (0.002), and had been admitted more frequently for heart failure (0.002), with fewer of them conserving sinus rhythm (p<0.001). Additionally, the pre-surgery existence of mitral regurgitation was associated with greater morbidity and mortality (10.5% vs 5.6%; p=0.025). The mitral regurgitation 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 3.7, p=0.038), and the absence of diabetes (OR 0.28, p=0.011) and pulmonary hypertension (0.33, p=0.046).
  
  
  CONCLUSIONS
  The presence of intermediate degree mitral regurgitation in patients undergoing isolated aortic valve replacement increases morbidity and mortality. However, a high percentage of those who do survive experience disappearance or improvement of the mitral regurgitation.
authors.affiliation: Heart Unit, Cardiology and Cardiac Surgery Service, Virgen de la Victoria Clinical University Hospital, Malaga, Spain. jcabbor1@hotmail.com <jcabbor1@hotmail.com>
authors.forename: Juan
authors.initials: J
authors.lastname: Caballero-Borrego
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gómez-Doblas
authors.forename: Fernando
authors.initials: F
authors.lastname: Cabrera-Bueno
authors.forename: José Manuel
authors.initials: JM
authors.lastname: García-Pinilla
authors.forename: José María
authors.initials: JM
authors.lastname: Melero
authors.forename: Carlos
authors.initials: C
authors.lastname: Porras
authors.forename: Eduardo
authors.initials: E
authors.lastname: Olalla
authors.forename: Eduardo
authors.initials: E
authors.lastname: De Teresa Galván
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome