Objective To evaluate clinical outcomes of mild-to-moderate or moderate functional mitral regurgitation(FMR)after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS),and analyze prognostic factors of these patients with mild-to-moderate or moderate FMR (2+to 3+). Methods From September 2008 to December 2011,a total of 156 patients with severe AS (peak aortic gradient (PAG)≥50 mm Hg) as well as FMR (2+to 3+) underwent surgical treatment in Zhongshan Hospital. There were 95 male and 61 female patients with their average age of 59.2±10.5 years. Detailed perioperative clinical data were collected,and postoperative patients were followed up. The ratio of FMRpreoperative/FMR postoperative was calculated. Patient age,gender,body weight,history of hypertension,ventricular arrhythmia,atrial fibrillation (AF),left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDD),left atrial diameter (LAD),pulmonary artery hypertension (PAH),PAG were assessed by logistic multivariate regression analysis. Results Six patients died postoperatively,including 4 patients with low cardiac output syndrome and 2 patients with refractory ventricular arrhythmia. Perioperative mortality was 3.8%. The average follow-up time was 20.3±8.5 months and follow-up rate was 85.3% (133/156). Eight patients died during follow-up,including 3 patients with heart failure,2 patients with ventricular arrhythmia,and 3 patients with anticoagulation-related cerebrovascular accident. Multivariate regression analysis showed that FMR preoperative/FMR postoperative ratio was not correlated with age≥55 years,male gender,body weight≥80 kg,LVEDD≥55 mm,LVEF≤50%,history of hypertension or ventricular arrhythmia. However,LAD≥50 mm,PAH≥50 mm Hg,PAG≤75 mm Hg and preoperative AF were negatively correlated with postoperative FMR improvement. Conclusions Risk factors including LAD≥50 mm,PAH≥50 mm Hg,PAG≤75 mm Hg and preoperative AF are negatively correlated with postoperative improvement of FMR (2+to 3+). Patients with severe AS and above risk factors should receive concomitant surgical treatment for their FMR during AVR,since preoperative FMR(2+to 3+)usually does not improve or even aggravate after AVR.