Change in Functional Moderate Mitral Regurgitation after Aortic Valve Replacement

Abstract

ObjectiveTo evaluate the changes of the mitral valve geometrics and the degrees of moderate mitral regurgitation (MR) in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS).MethodsA retrospective analysis study of intraoperative transesophageal echocardiography (TEE) and postoperative transthoracic echocardiography (TTE) was performed in 49 patients diagnosed with pure AS combined with moderate MR, who underwent AVR from January 2013 to December 2017. TEE was used to evaluate the direct geometric changes of the mechanical effects on mitral annulus after AVR. TTE was used to evaluate the changes of MR after operation. All patients underwent TTE during the midterm follow-up. The mean follow-up time was 40.21 months.ResultsAll of the 49 patients had moderate MR. Anterolateral-posteromedial diameter, anterior-posterior diameter, and mitral annular area were significantly reduced after AVR, while no significant changes were found in the intraoperative left ventricular loading conditions before and after AVR. The degree of mitral valve regurgitation, left ventricular size, left atrial size, left ventricular end-diastolic volume, and left ventricular to aortic pressure gradient were significantly reduced before discharge, and midterm follow-up showed good results.ConclusionThis study supports the belief that aortic outflow tract obstruction and an actual mechanical compression of the anterior mitral annulus after AVR would cause reduction in MR. Ventricular remodeling would also cause reduction in MR with time going on. Patients with AS, especially young patients with moderate MR, were most likely to benefit from AVR in early time.

Early Results and Fate of Moderate Mitral Regurgitation in Patients Undergoing Surgical Aortic Valve Replacement

“…Wang et al (5) evaluated the variations in MV geometry and the degree of MR in studied cases undergoing AVR and reported a mean age of 52.6 (SD 12) years and had no significance with MV changes.…”

Concomitant Mitral Regurgitation in Patients Undergoing Surgical Aortic Valve Replacement for Aortic Stenosis: A Systematic Review

“…24) In the setting of severe AS, functional MR can often coexist. 9) The chronic increase in transaortic valve gradient and intraventricular pressure coupled with subsequent LV remodeling is thought to provoke this secondary MR. The reduction in aortic valve gradient following an AVR has the potential to improve any concomitant MR as a result of decreased LV pressure, altered mitral annulus size and reverse LV remodeling in the long term.…”

“…[6][7][8] However, when the degree of MR is moderate or less, the clinical decision to intervene is often held in equipoise. 9) The severity of functional MR can be expected to improve following an AVR with myocardial remodeling and subsequent enhancement of overall haemodynamics. 1) With this anticipated improvement and the increasing morbidity and mortality risk of a double valve intervention, expectant management of concomitant MR is justifiable when the severity is moderate or less.…”

“…1) With this anticipated improvement and the increasing morbidity and mortality risk of a double valve intervention, expectant management of concomitant MR is justifiable when the severity is moderate or less. 9) However, the degree of change in MR following AVR varies considerably and the proportion of patients exhibiting improvement is inconsistent, ranging from 23% to 82%. [10][11][12] Conflicting reports have also demonstrated a proportion of patients who experience unchanged or worsening severity of MR. 13) In addition, poorer longterm outcomes in patients left with persistent MR following AVR have been reported in some studies.…”

“… 6 – 8) However, when the degree of MR is moderate or less, the clinical decision to intervene is often held in equipoise. 9) …”