Fate of Functional Mitral Regurgitation after Aortic Valve Replacement in Patients with Aortic Valve Stenosis

Abstract

Objective: Functional mitral regurgitation(f-MR) is seen in varying degrees in aortic valve stenosis(AS). Repairing f-MR in the same session with aortic valve replacement(AVR) is controversial. Aim of this study is to reveal whether surgical intervention was necessary for f-MR or not, in the same session. Materials and Methods: 118 patients who underwent AVR due to AS with accompanying f-MR between 2013 and 2018 were evaluated retrospectively. Patients with coronary heart disease requiring surgery, degenerative and/or rheumatic mitral valvular lesions were excluded. Demographic data, pre/postoperative peak aortic valve gradient(AVG), mean AVG, mitral valve structure, f-MR degree, left ventricular end-diastolic(LVEDD)/end-systolic(LVESD) diameters, right(RAD)/left(LAD) atrial diameters, pulmonary artery pressures(tPAP), vena contracta(VC) and aortic valve velocities were analysed. Results: Mean age was 61,72±5,97. AS with aortic regurgitation and isolated AS was present in 18,64%(n=22) and 81,35%(n=96) of the patients. f-MR was mild in 66,10%(n=78), mild-moderate in 11,86%(n=14), moderate in 16,90%(n=20) and moderate-severe in 5,08%(n=6) of the patients, preoperatively. After AVR, f-MR was mild in 74,57%(n=88), mild-moderate in 6,77%(n=8), moderate in 18,64%(n=22) of the patients. No significant changes were present in ejection fraction(p=0,968), LAD(p=0,955) and RAD(p=0,264). Significant decreases were determined in peak-AVG(p=0,000), mean-AVG(p=0,000), LVEDD(p=0,000), LVESD(p=0,000), tPAP(p=0,021) and aortic valve velocity(p=0,000). Conclusion: We conclude that AVR is sufficient to reduce/eliminate f-MR to safer limits in patients with accompanying mild, mild-moderate and moderate f-MR. However, f-MR reduced only to moderate, in some patients with moderate-severe f-MR after AVR. So, we only recommend repairing mitral valve concurrently with AVR in patients having higher than moderate f-MR.