Moderate mitral regurgitation in aortic root replacement surgery: Comparing mitral repair with no mitral repair

Abstract

Mitral repair along with aortic root replacement has acceptable operative risk. Aortic root replacement surgery alone improved mitral regurgitation, but the addition of mitral repair further reduced mitral regurgitation, suggesting that repairing moderate mitral regurgitation should generally be considered along with aortic root replacement.

Outcomes of Aortic Root Replacement After Previous Aortic Root Replacement: The “True” Redo Root

“…This is evidenced by the higher rate of mitral valve interventions in the redo group, primarily in the infection group. In our hands, the addition of mitral valve repair or replacement at the time of aortic root replacement did not result in increased morbidity or death (Table 5) [26].…”

Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrection

“…McCarthy and associates 17 compared, in a retrospective study, outcomes in a series of 1316 patients undergoing aortic root replacement who did or did not receive a concomitant mitral repair via left atrial approach in the presence of preoperative moderate mitral regurgitation. In their series, crossclamp time increased by more than 1 hour (crossclamp time concomitant mitral valve repair ¼ 244.8 AE 42 minutes vs no concomitant mitral valve repair ¼ 179.6 AE 50.6 minutes) in patients undergoing additional mitral valve repair.…”

“… 15 As postoperative persistence of mitral valve regurgitation has been shown to affect survival adversely, a concomitant mitral valve approach may be added to a challenging aortic root/valve or left ventricular remodeling procedure to avoid that risk. 16 , 17 , 18 In these cases, reduction of surgical time spent for mitral repair is key.…”

Echocardiographic evaluation of non-surgically treated mild-to-moderate mitral dysfunction in patients undergoing aortic valve replacement

“…Conservative management of less severe MV disease has many benefits, including the avoidance of unnecessary MV surgery [5–9], a shorter aortic cross/operation time, and consequently a lower perioperative morbidity and mortality than double valve surgery [10, 11]. However, this conservative approach may lead to a higher chance of reoperation resulting from unchanged or worsened mitral pathology [12, 13] and lesser hemodynamic improvement than surgery [14].…”

“…Because of limited data and the lack of randomized control trials, even the present 2014 ACC/AHA guidelines do not provide clear recommendations for managing MV disease [15]. In 2013, some studies provided relevant clinical insights into this disease [14, 16]. However, there is still insufficient evidence to resolve the issue, especially regarding organic MV pathology and the paucity of long-term echocardiographic data [6, 12, 13, 17, 18].…”