What happens to functional mitral regurgitation after aortic valve replacement for aortic stenosis?
BACKGROUND
Patients with aortic stenosis (AS) treated with aortic valve replacement (AVR) may also present with associated functional mitral valve regurgitation (FMR). Whether to also address the mitral valve at the time of AVR remains unclear. This study was designed to determine the influence of MR on survival and its evolution over time.


METHODS
We retrospectively reviewed 74 patients with FMR who underwent isolated AVR between 1999 and 2006 at our institution. Inclusion criteria were surgery for AVR with severe AS (mean age, 69 years; N = 47; 64% women) and FMR (grade I, 80%; grade II, 19%; grade III, 1%). Echocardiography follow-up data were obtained by mail questionnaires sent to the referring cardiologists of all survivors. All parameters were analyzed with the Kaplan-Meier method and the sign test.


RESULTS
The operative mortality rate was 2%, and 9 patients (12%) died during follow-up. The mean (SD) follow-up time was 48 ± 33 months, and follow-up 96% complete. The follow-up demonstrated a decrease of FMR by 2 degrees in 3 patients (4%), and 1 degree in 14 patients (19%); regurgitation remained unchanged in the majority of patients (n = 47; 63%). FMR worsened in 10 patients overall (14%), and new-onset atrial fibrillation was found in 24 patients (33%); however, the statistical analysis failed to demonstrate an impact of worsening FMR on survival.


CONCLUSIONS
MR in patients with severe AS and FMR at the time of AVR does not appear to worsen significantly over time. Not dealing with the mitral valve at the time of AVR might be warranted for selected patients.
Department of Cardiac and Vascular Surgery, University Hospital Zurich, Zurich.
Stephanie
S
Wyler
Maximilian Y
MY
Emmert
Patric
P
Biaggi
Burkhardt
B
Seifert
Jürg
J
Grünenfelder
Volkmar
V
Falk
Sacha
S
Salzberg
D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D015897:Comorbidity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome