Treatment of moderate functional mitral regurgitation during aortic valve replacement in patients with aortic valve disease: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Xieraili·Tiemuerniyazi ,  XU Fei , SONG Yangwu , NAN Yifeng , FENG Wei

Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

XU Fei, Email: felix_xufei@126.com

Keywords：

Aortic valve replacement; functional mitral regurgitation; mitral valve repair; mitral valve replacement

DOI：

10.7507/1007-4848.202008059

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Objective To evaluate the impact of different surgical strategies for moderate functional mitral regurgitation (FMR) at the time of aortic valve replacement (AVR) on patients' prognosis.Methods A total of 118 AVR patients, including 84 males and 34 females, aged 58.1±12.4 years, who were complicated with moderate FMR were retrospectively recruited. Patients were divided into three groups according to the treatment strategy of mitral valve: a group A (no intervention, n=11), a group B (mitral valve repair, n=51) and a group C (mitral valve replacement, n=56). The primary endpoint was the early and mid-term survival of the patients, and the secondary endpoint was the improvement of FMR.Results The median follow-up time was 29.5 months. Five patients died perioperatively, all of whom were from the group C. Early postoperative FMR improvement rates in the group A and group B were 90.9% and 94.1% (P=0.694). The mid-term mortality in the three groups were 0.0%, 5.9% and 3.9%, respectively (P=0.264), while the incidences of major cardiovascular and cerebrovascular events were 0.0%, 9.8% and 17.7%, respectively (P=0.230). Improvements of FMR in the group A and group B were 100.0% and 94.3% at the mid-term follow-up (P>0.05).Conclusion For patients receiving AVR with moderate FMR, conservative treatment or concurrent repair of mitral valve may be more reasonable, while mitral valve replacement may increase the incidence of early and mid-term adverse events.

Citation： Xieraili·Tiemuerniyazi, XU Fei, SONG Yangwu, NAN Yifeng, FENG Wei. Treatment of moderate functional mitral regurgitation during aortic valve replacement in patients with aortic valve disease: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 74-79. doi: 10.7507/1007-4848.202008059 Copy

1.	Bonow RO, O'Gara PT, Adams DH, et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: A report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
2.	Moazami N, Diodato MD, Moon MR, et al. Does functional mitral regurgitation improve with isolated aortic valve replacement? J Card Surg, 2004, 19(5): 444-448.
3.	Schubert SA, Yarboro LT, Madala S, et al. Natural history of coexistent mitral regurgitation after aortic valve replacement. J Thorac Cardiovasc Surg, 2016, 151(4): 1032-1039.
4.	Sorabella RA, Olds A, Yerebakan H, et al. Is isolated aortic valve replacement sufficient to treat concomitant moderate functional mitral regurgitation? A propensity-matched analysis. J Cardiothorac Surg, 2018, 13(1): 72.
5.	Kowalowka AR, Onyszczuk M, Wanha W, et al. Do we have to operate on moderate functional mitral regurgitation during aortic valve replacement for aortic stenosis? Interact Cardiovasc Thorac Surg, 2016, 23(5): 806-809.
6.	Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J, 2019, 40(3): 237-269.
7.	高润霖. 中国心瓣膜病现状. 华西医学, 2018, 33(2): 127-131.
8.	Brener SJ, Duffy CI, Thomas JD, et al. Progression of aortic stenosis in 394 patients: Relation to changes in myocardial and mitral valve dysfunction. J Am Coll Cardiol, 1995, 25(2): 305-310.
9.	Alghamdi AA, Elmistekawy EM, Singh SK, et al. Is concomitant surgery for moderate functional mitral regurgitation indicated during aortic valve replacement for aortic stenosis? A systematic review and evidence-based recommendations. J Card Surg, 2010, 25(2): 182-187.
10.	Khosravi A, Sheykhloo H, Karbasi-Afshar R, et al. Echocardiographic changes after aortic valve replacement: Does the failure rate of mitral valve change? ARYA Atheroscler, 2015, 11(2): 147-152.
11.	Wyler S, Emmert MY, Biaggi P, et al. What happens to functional mitral regurgitation after aortic valve replacement for aortic stenosis? Heart Surg Forum, 2013, 16(5): E238-E242.
12.	Absil B, Dagenais F, Mathieu P, et al. Does moderate mitral regurgitation impact early or mid-term clinical outcome in patients undergoing isolated aortic valve replacement for aortic stenosis? Eur J Cardiothorac Surg, 2003, 24(2): 217-222.
13.	Wan CK, Suri RM, Li Z, et al. Management of moderate functional mitral regurgitation at the time of aortic valve replacement: Is concomitant mitral valve repair necessary? J Thorac Cardiovasc Surg, 2009, 137(3): 634-640.
14.	Waisbren EC, Stevens LM, Avery EG, et al. Changes in mitral regurgitation after replacement of the stenotic aortic valve. Ann Thorac Surg, 2008, 86(1): 56-62.
15.	Sehovic S, Talic A, Kacila M, et al. The influence of aortic valve replacement on functional moderate-to-severe mitral regurgitation in patients with aortic valve stenosis. Acta Inform Med, 2015, 23(3): 147-150.
16.	Shingu Y, Iwano H, Murakami T, et al. Risk factors for residual mitral regurgitation after aortic valve replacement in patients with severe aortic valve stenosis and moderate mitral regurgitation. Gen Thorac Cardiovasc Surg, 2019, 67(10): 849-854.
17.	Ruel M, Kapila V, Price J, et al. Natural history and predictors of outcome in patients with concomitant functional mitral regurgitation at the time of aortic valve replacement. Circulation, 2006, 114(1 Suppl): I541-I546.
18.	Joo HC, Chang BC, Cho SH, et al. Fate of functional mitral regurgitation and predictors of persistent mitral regurgitation after isolated aortic valve replacement. Ann Thorac Surg, 2011, 92(1): 82-87.
19.	Coutinho GF, Correia PM, Pancas R, et al. Management of moderate secondary mitral regurgitation at the time of aortic valve surgery. Eur J Cardiothorac Surg, 2013, 44(1): 32-40.
20.	Jeong DS, Park PW, Sung K, et al. Long-term clinical impact of functional mitral regurgitation after aortic valve replacement. Ann Thorac Surg, 2011, 92(4): 1339-1345.
21.	Talwar S, Mathur A, Choudhary SK, et al. Aortic valve replacement with mitral valve repair compared with combined aortic and mitral valve replacement. Ann Thorac Surg, 2007, 84(4): 1219-1225.
22.	Kim GS, Kim JB, Han S, et al. Mitral valve repair versus replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement. Interact Cardiovasc Thorac Surg, 2014, 18(1): 73-79.

1. Bonow RO, O'Gara PT, Adams DH, et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: A report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
2. Moazami N, Diodato MD, Moon MR, et al. Does functional mitral regurgitation improve with isolated aortic valve replacement? J Card Surg, 2004, 19(5): 444-448.
3. Schubert SA, Yarboro LT, Madala S, et al. Natural history of coexistent mitral regurgitation after aortic valve replacement. J Thorac Cardiovasc Surg, 2016, 151(4): 1032-1039.
4. Sorabella RA, Olds A, Yerebakan H, et al. Is isolated aortic valve replacement sufficient to treat concomitant moderate functional mitral regurgitation? A propensity-matched analysis. J Cardiothorac Surg, 2018, 13(1): 72.
5. Kowalowka AR, Onyszczuk M, Wanha W, et al. Do we have to operate on moderate functional mitral regurgitation during aortic valve replacement for aortic stenosis? Interact Cardiovasc Thorac Surg, 2016, 23(5): 806-809.
6. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J, 2019, 40(3): 237-269.
7. 高润霖. 中国心瓣膜病现状. 华西医学, 2018, 33(2): 127-131.
8. Brener SJ, Duffy CI, Thomas JD, et al. Progression of aortic stenosis in 394 patients: Relation to changes in myocardial and mitral valve dysfunction. J Am Coll Cardiol, 1995, 25(2): 305-310.
9. Alghamdi AA, Elmistekawy EM, Singh SK, et al. Is concomitant surgery for moderate functional mitral regurgitation indicated during aortic valve replacement for aortic stenosis? A systematic review and evidence-based recommendations. J Card Surg, 2010, 25(2): 182-187.
10. Khosravi A, Sheykhloo H, Karbasi-Afshar R, et al. Echocardiographic changes after aortic valve replacement: Does the failure rate of mitral valve change? ARYA Atheroscler, 2015, 11(2): 147-152.
11. Wyler S, Emmert MY, Biaggi P, et al. What happens to functional mitral regurgitation after aortic valve replacement for aortic stenosis? Heart Surg Forum, 2013, 16(5): E238-E242.
12. Absil B, Dagenais F, Mathieu P, et al. Does moderate mitral regurgitation impact early or mid-term clinical outcome in patients undergoing isolated aortic valve replacement for aortic stenosis? Eur J Cardiothorac Surg, 2003, 24(2): 217-222.
13. Wan CK, Suri RM, Li Z, et al. Management of moderate functional mitral regurgitation at the time of aortic valve replacement: Is concomitant mitral valve repair necessary? J Thorac Cardiovasc Surg, 2009, 137(3): 634-640.
14. Waisbren EC, Stevens LM, Avery EG, et al. Changes in mitral regurgitation after replacement of the stenotic aortic valve. Ann Thorac Surg, 2008, 86(1): 56-62.
15. Sehovic S, Talic A, Kacila M, et al. The influence of aortic valve replacement on functional moderate-to-severe mitral regurgitation in patients with aortic valve stenosis. Acta Inform Med, 2015, 23(3): 147-150.
16. Shingu Y, Iwano H, Murakami T, et al. Risk factors for residual mitral regurgitation after aortic valve replacement in patients with severe aortic valve stenosis and moderate mitral regurgitation. Gen Thorac Cardiovasc Surg, 2019, 67(10): 849-854.
17. Ruel M, Kapila V, Price J, et al. Natural history and predictors of outcome in patients with concomitant functional mitral regurgitation at the time of aortic valve replacement. Circulation, 2006, 114(1 Suppl): I541-I546.
18. Joo HC, Chang BC, Cho SH, et al. Fate of functional mitral regurgitation and predictors of persistent mitral regurgitation after isolated aortic valve replacement. Ann Thorac Surg, 2011, 92(1): 82-87.
19. Coutinho GF, Correia PM, Pancas R, et al. Management of moderate secondary mitral regurgitation at the time of aortic valve surgery. Eur J Cardiothorac Surg, 2013, 44(1): 32-40.
20. Jeong DS, Park PW, Sung K, et al. Long-term clinical impact of functional mitral regurgitation after aortic valve replacement. Ann Thorac Surg, 2011, 92(4): 1339-1345.
21. Talwar S, Mathur A, Choudhary SK, et al. Aortic valve replacement with mitral valve repair compared with combined aortic and mitral valve replacement. Ann Thorac Surg, 2007, 84(4): 1219-1225.
22. Kim GS, Kim JB, Han S, et al. Mitral valve repair versus replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement. Interact Cardiovasc Thorac Surg, 2014, 18(1): 73-79.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment of moderate functional mitral regurgitation during aortic valve replacement in patients with aortic valve disease: A retrospective cohort study

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