title: Management of concomitant mild to moderate functional mitral regurgitation during aortic valve surgery for severe aortic insufficiency.
abstract: OBJECTIVE
  The optimal management of mild to moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) for severe aortic insufficiency (AI) is poorly defined. We aimed to investigate the fate of FMR after AVR with or without concomitant mitral annuloplasty (MAP) and to identify the risk factors and clinical implications of persistent FMR.
  
  
  METHODS
  Between June 1996 and August 2011, 155 patients with mild to moderate FMR undergoing AVR for severe AI were reviewed. The preoperative MR grade was mild in 101 patients (65%) and moderate in 54 patients (35%). Persistent FMR was defined as MR grade remaining the same or increased on the last follow-up echocardiogram.
  
  
  RESULTS
  The mean follow-up duration was 4.5 ± 3.9 years. FMR improved in 88% of the patients. On multivariate analysis, left ventricular end-diastolic dimension (LVEDD) reduction after AVR was identified as the only predictor for FMR improvement (P = .004; hazard ratio, 0.927; confidence interval, 0.881 to 0.977). Concomitant MAP did not show additional benefit in preventing persistent FMR (P = .35). Although no survival difference was observed between the patients with and without persistent FMR (P = .78), persistent FMR was associated with greater heart failure events (P < .001).
  
  
  CONCLUSIONS
  Mild to moderate FMR as a result of severe AI improved with AVR in most patients with or without concomitant MAP. Poor postoperative LVEDD reduction was the only risk factor for persistent FMR. Because persistent FMR tended to be associated with heart failure events, close echocardiographic monitoring and proactive medical management are recommended in patients showing poor LVEDD reduction after AVR.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors.forename: Ju Yong
authors.initials: JY
authors.lastname: Lim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul St. Mary Hospital, Seoul, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Song
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. Electronic address: sjchoo@amc.seoul.kr.
authors.forename: Suk-Jung
authors.initials: SJ
authors.lastname: Choo
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome