title: Outcomes following surgical correction of pure aortic regurgitation in presence or absence of significant functional mitral regurgitation.
abstract: BACKGROUND
  Functional mitral regurgitation (MR) can occur secondary to severe aortic regurgitation (AR). However, data on the overall impact of mitral surgical intervention after aortic valve replacement (AVR) are scarce. We sought to study the left ventricular (LV) remodeling process and determine predictors of clinical outcomes of patients with pure severe AR in presence or absence of significant functional MR.
  
  
  METHODS
  Patients were categorized into AR-MR group (≤ mild MR; n = 51, 76%) and AR + MR group (≥ moderate MR; n = 16, 24%). All patients in the AR + MR group underwent AVR and MR correction. Serial echocardiographic measurements and clinical follow-up up to 5 years were obtained in all patients.
  
  
  RESULTS
  Significant reverse LV remodeling occurred in both groups compared with baseline. No 30-day deaths occurred. Mortality and heart failure-related hospitalization rates, at follow-up, were significantly higher in the AR + MR group (19% vs. 2%, P = 0.04 and 38% vs. 12% P = 0.03, respectively), but a similar proportion of patients from both groups was in New York Heart Association class I or II (87% vs. 92%, P = 0.62). Preoperative indexed stroke volume (SV) <50 mL/m2 was the only independent predictor of death and/or rehospitalization after surgery (odds ratio: 61.1, [95% CI, 12.6–425.2]; P < 0.0001).
  
  
  CONCLUSIONS
  Despite being a higher risk population, patients with moderate-to-severe functional MR secondary to severe AR experience similar postoperative mortality at the expense of a moderately higher 5-year overall mortality, rate of hospitalization for congestive heart failure, and medication use. Preoperative indexed SV < 50 mL/m2 may be helpful in predicting long-term outcomes.
authors.forename: Jimmy
authors.initials: J
authors.lastname: MacHaalany
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.forename: Kim
authors.initials: K
authors.lastname: O'Connor
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bernier
authors.forename: Isaie-Nicolas
authors.initials: IN
authors.lastname: Dubois-Sénéchal
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Jacques
authors.forename: Isabelle
authors.initials: I
authors.lastname: Viel
authors.forename: Michelle
authors.initials: M
authors.lastname: Dubois
authors.forename: Mario
authors.initials: M
authors.lastname: Sénéchal
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography; D020257:Ventricular Remodeling