title: Moderate mitral regurgitation in aortic root replacement surgery: comparing mitral repair with no mitral repair.
abstract: OBJECTIVE
  Patients often present for aortic root replacement surgery with concomitant mitral valve pathology. Moderate mitral regurgitation is the point of clinical equipoise where the benefits of intervention compared with observation are currently unknown. This study compares outcomes in patients undergoing aortic root replacement surgery who did or did not receive a mitral valve repair for their preoperative moderate mitral regurgitation.
  
  
  METHODS
  A total of 1316 patients who underwent aortic root replacement surgery between 2000 and 2011 were evaluated, with 104 patients meeting the inclusion criteria by presenting with moderate preoperative mitral regurgitation. A total of 73 patients (70%) received no mitral intervention, and 31 patients (30%) received a mitral repair. Patients underwent preoperative, postoperative, and greater than 6-month follow-up echocardiograms. Average clinical follow-up was 6.5 years.
  
  
  RESULTS
  The mitral repair group had increased preoperative New York Heart Association III/IV and heart failure, longer crossclamp times, and more postoperative renal failure (P = .0003, P = .04, P < .0001, and P = .03, respectively). The improvement in mitral regurgitation was greater for the mitral repair group (-2.1 ± 0.3 vs -1.1 ± 0.8, P < .0001), and mitral regurgitation remained significantly lower on follow-up at 6 months or more (0.6 ± 0.4 0.9 ± 0.2, P = .002). A significantly greater percentage of patients undergoing mitral repair compared with patients with no repair had improvement of at least 1 grade in mitral regurgitation postoperatively (100% vs 70%, P = .001) and on follow-up at 6 months or more (90% vs 61%, P = .006). There was no difference in long-term survival, freedom from 2+ or greater mitral regurgitation, or mitral reinterventions.
  
  
  CONCLUSIONS
  Mitral repair along with aortic root replacement has acceptable operative risk. Aortic root replacement surgery alone improved mitral regurgitation, but the addition of mitral repair further reduced mitral regurgitation, suggesting that repairing moderate mitral regurgitation should generally be considered along with aortic root replacement.
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa. Electronic address: Fenton.McCarthy@uphs.upenn.edu.
authors.forename: Fenton H
authors.initials: FH
authors.lastname: McCarthy
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Fox
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Justin
authors.initials: J
authors.lastname: George
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Patrick
authors.initials: P
authors.lastname: Moeller
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
mesh_terms: D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015994:Incidence; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome