Mild to moderate aortic regurgitation (Grade II) at the time of mitral surgery: mid term course

Abstract

Objective: A considerable proportion of patients who require mitral valve replacement present with a coexisting pathology of the aortic valve (AV). Rheumatic fever remains the leading cause for combined disease This study evaluates the mid-term course of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery: what is the appropriate treatment of mild aortic valve disease while replacing the mitral valve. The purpose of this study was to assess mid term clinical outcome and the need for subsequent aortic valve replacement in patients with mild to moderate rheumatic aortic valve disease at the time of mitral valve surgery. Material and methods: Between 2000 and 2009, Two-hundred seventy-seven patients were followed after mitral valve surgery. All patients had rheumatic heart disease. Aortic valve function was assessed preoperatively and during follow-up by transthoracic echocardiography. Our studies included two groups: – Group A: 154 patients (mitral surgery – aortic valve neglected). – Group B: 123 patients (mitral surgery and aortic valve replacement). Results: As results, global hospital mortality was 2,52% (07 patients): 01 patient in group A and 06 patients in group B (dns: p > 0,05). Average follow-up period for the 154 patients (group A) was 54.33 months, in group B was 49.53 months; in other hand, 19 patients were lost (6.85%). Global late mortality was 5.41% (16 patients): 05.84% in group A (09 patients) and 4.84% (06 patients) in group B. five-year survival rates in groups A and B were 89.5% and 84.7% respectively in group A and B (dns: p > 0,05). At the end of the follow-up period, in group A, 03 patients required surgery for moderate to severe AV disease and functional repercussion. Conclusion: Our findings indicate that, among patients with rheumatic heart disease, a considerable number of patients have mild aortic valve disease at the time of mitral valve surgery. Most do not progress to severe disease, and aortic valve replacement is rarely needed. In these cases, after evaluate aortic regurgitation during both cardioplegia and aortic valve inspection, replacement of the aortic valve should taking in consideration age, sex, life condition of the patient, preoperative lef ventricle condition (altered left ventricle functio); the decision to replace the aortic valve should be considered in this conditions and when the mitral was replaced, and in the case of previous cardiac surgery. we thought that prophylactic valve replacement is not indicated in these cases.