Long-Term Clinical Impact of Functional Mitral Regurgitation After Aortic Valve Replacement

Abstract

We evaluated the impact of functional mitral regurgitation (MR) on clinical outcomes and to identify predictors of residual MR after aortic valve replacement in aortic stenosis. Three hundred and eighty-four patients who underwent primary aortic valve replacement for aortic stenosis were enrolled. Patients were divided into the no-MR group (no or trivial MR; n = 270) and the MR group (mild to moderate MR; n = 114). In the MR group, 19 patients underwent concomitant mitral valve repairs. Mean follow-up duration was 4.5 ± 3.7 years (range, 1 to 15 years). Clinical and echocardiographic data were analyzed. There was no operative mortality, but there were 9 late cardiac deaths (2.3%). Freedom from cardiac death at 14 years was lower in the MR group than in the no-MR group (77.8% ± 12.6% versus 97.7% ± 1.4%, respectively; p = 0.045), and freedom from heart failure events at 10 years was also lower in the MR group (60.8% ± 13.4% versus 92.6% ± 2.2%, p = 0.043). On multivariate analysis, preoperative atrial fibrillation and left ventricular ejection fraction greater than 40% were predictors for residual MR at late follow-up in the untreated MR group. Cox regression analysis demonstrated that postoperative moderate MR predicted late cardiac death (p = 0.016, hazard ratio 5.2). In the MR group, the incidence of residual MR in patients who underwent mitral valve repair was 5.6% (versus 30.7% in patients without mitral valve repair, p = 0.001). Functional MR in aortic stenosis was related to poor clinical outcomes. The results of this study suggest that concomitant mitral valve procedures could be considered in selected patients with aortic stenosis and functional MR.