Factors determining early improvement in mitral regurgitation after aortic valve replacement for aortic valve stenosis: A transthioracic and transesophageal prospective study

Tassan-Mangina, Sophie; Metz, Damien; Nazeyrollas, Pierre; Torossian, F; Pop, C; B, Jamet; Baehrel, B; Elaerts, J

doi:10.1002/clc.4960260306

Cited by 49 publications

(61 citation statements)

References 14 publications

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“…In fact, AVR for AS, by reducing left ventricular (LV) afterload, might have the potential to improve mitral valve competence through reverse LV remodeling and reduced mitral annular size. Several authors 2,[5][6][7][8][9][10][11][12][13] have attempted to determine predictive factors for MR changes after surgery. However, these studies, mostly limited by their retrospective nature and/or by the qualitative or semi-quantitative assessment of MR, have given conflicting results.…”

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confidence: 99%

Effects of Valve Replacement for Aortic Stenosis on Mitral Regurgitation

Unger¹,

Plein²,

Camp³

et al. 2008

The American Journal of Cardiology

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We aimed to prospectively and quantitatively assess the effects of aortic valve replacement (AVR) for aortic stenosis (AS) on mitral regurgitation (MR) and to examine the determinants of the changes in MR. Fifty-two patients with AS scheduled for AVR were included if holosystolic MR not being considered for replacement or repair was detected. MR was quantified using the proximal isovelocity surface area method before and 8 ؎ 4 days after surgery. Mitral valvular deformation parameters did not change significantly, but the mitral effective regurgitant orifice (ERO) and regurgitant volume decreased from 11 ؎ 6 mm 2 to 8 ؎ 6 mm 2 and from 20 ؎ 10 ml to 11 ؎ 9 ml, respectively (both p <0.0001). Using multiple linear regression analysis, preoperative severity of MR, mitral leaflet coaptation height, and end-diastolic volume decrease were independently associated with postoperative reduction in MR, whereas changes in mitral valve morphology after surgery were not. Mitral regurgitation (MR) is a common finding in patients with aortic stenosis (AS). The severity of the MR increases over time in relation to the increase in transaortic pressure gradient.1 At the time of aortic valve replacement (AVR), up to two-thirds of patients with AS exhibit varying degrees of MR.2 Because combined aortic and mitral valve replacement markedly increases the operative risk and affects longterm morbidity and mortality, 3,4 it has been suggested that MR does not require specific treatment because downgrading of MR usually occurs after isolated AVR. In fact, AVR for AS, by reducing left ventricular (LV) afterload, might have the potential to improve mitral valve competence through reverse LV remodeling and reduced mitral annular size. Several authors 2,5-13 have attempted to determine predictive factors for MR changes after surgery. However, these studies, mostly limited by their retrospective nature and/or by the qualitative or semi-quantitative assessment of MR, have given conflicting results. Indeed, the percentage of patients with reduced MR ranges from Ͼ80% 9 to Ͻ30%.8 No study has used a quantitative method for assessing MR in this setting. The extent and determinants of changes in MR after AVR, therefore, remain to be determined. Whether postoperative changes in MR reflect LV hemodynamics or LV and mitral valve geometric changes is unknown. We therefore aimed to prospectively and quantitatively assess the effects of AVR on MR severity and to examine the determinants of postoperative changes in MR. MethodsPatients were included in this multicenter study if they presented with severe AS and were scheduled for AVR and had at least mild holosystolic MR. Patients with MR being considered for a concomitant mitral valve procedure were excluded, as were patients with previous mitral valve surgery, technically inadequate echocardiogram, or greater than moderate aortic regurgitation (vena contracta width Ͼ6 mm). Patients were also subsequently excluded from the study if any surgical procedure on the mitral valve (repair or replacement) was pe...

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mentioning

confidence: 99%

Effects of Valve Replacement for Aortic Stenosis on Mitral Regurgitation

Unger¹,

Plein²,

Camp³

et al. 2008

The American Journal of Cardiology

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“…Our study fo und that, im pro ve ment of MR was not asso ci a ted with the mit ral cal ci fi ca ti on or at ri al di lati on re por ted el sew he re, 5 tho ugh this may be du e to the low pre va len ce of mit ral cal ci fi ca ti on (29.8%) in com pa ri son with ot her stu di es. 15 Our study ag ree with Emily et al, 16 study as we fo und that: con serva ti ve, ta i lo red ap pro ach to con co mi tant mit ral surgery in pa ti ent pre sen ting for cor rec ti on of aor tic ste no sis who de mons tra te func ti o nal mit ral re gurgi ta ti on.…”

Section: Mr (38)mentioning

confidence: 53%

“…4 Alt ho ugh im pro ve ments in deg re e of MR ha ve be en re por ted af ter iso la ted AVR. 5,6 The abi lity to pre dict per sis tent MR af ter AVR is con si de red im por tant, but re la ti vely few stu di es ha ve analy zed the cli ni cal im pact of functi o nal MR. Furt her mo re, the ma jo rity of per for med stu di es ha ve be en of small sca le and ha ve not exami ned func ti o nal out co mes or so ught to iden tify pre dic tors of per sis tent MR.…”

Section: Effect Of Aortic Valve Replacementmentioning

confidence: 99%

Effect of Aortic Valve Replacement, for Aortic Stenosis, on Concomitant Mitral Valve Regurgitation

Aljadayel¹,

Alkanj²

2015

Turkiye Klinikleri J Cardiovasc Sci

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Mild-to-moderate mitral regurgitation (MR) often coexists with severe aortic stenosis and has been reported to be presented in up to 2/3 patients requiring aortic valve replacement (AVR). MR in patients with aortic stenosis is often functional in nature although organic mitral disease may coexist. Increased afterload and left ventricular remodeling have been implicated to explain the functional MR in patients with aortic valve stenosis. Furthermore, remodeling observed after AVR may impact the outcome of MR postoperatively. However, the clinical outcome of persistent MR after AVR is uninvestigated. On the other hand, concomitant replacement of the aortic and mitral valves is associated with an increased morbidity and mortality compared to an isolated AVR. This study aims to assess the change in MR severity following AVR for severe AS and to determine the factors associated with the MR improvement. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The clinical and surgical characteristics were compared in a cohort of 149 consecutive patients who underwent isolated AVR in Aleppo University Hospital for cardiac surgery. R Re es su ul lt ts s: : Non-severe functional mitral valve regurgitation was detected prior to surgery in 25.5% of the patients. These patients were older (p = 0.007), more often had ventricular dysfunction (p = 0.02) and pulmonary hypertension (p = 0.04), and had been admitted more frequently for heart failure (0.008), with fewer of them conserving sinus rhythm (p = 0.003). In addition, the pre-surgery existence of MR was associated with greater morbidity and mortality (5.2% vs. 3.7%; p = 0.025). The MR disappeared or improved prior to hospital discharge in 56.2% and 15.6%, respectively. Independent factors predicting this improvement were the presence of coronary lesions (OR 3.74, p = 0.03), and the absence of diabetes (OR 0.28, p = 0.005) as well as pulmonary hypertension (OR 0.34, p = 0.01). C Co on nc cl lu u--s si io on n: : In this study, MR decreased or disappeared in a high percentage of patients after AVR surgery. Independent factors predicting this improvement included the presence of prior coronary lesions, although the improvement is influenced by the diabetic status of the patient, as well as pulmonary hypertension. K Ke ey y W Wo or rd ds s: : Cardiac valve annuloplasty; cardiomegaly; cardiac resynchronization therapy; vascular stiffness; venous valves; thoracic surgery Ö ÖZ ZE ET T A Am ma aç ç: : Hafiften ılımlıya mitral regürjitasyonda (MR) genellikle şiddetli aort stenozu (AS) birlikte bulunur ve başvuran hastaların 2/3'ünden fazlasında aort kapağı replasmanı (AVR) gerektiği bildirilmiştir. Aort stenozlu MR olguları sıklıkla işlevsel yapıda olmalarına rağmen, organik mitral kapak hastalığı eş zamanlı bulunabilir. Aortik kapak stenozlu fonksiyonel MR hastalarında artmış ard yük ve sol ventrikülün yeniden şekillenmesi söz konusudur. Hatta, AVR sonrası gözlenen bu yeniden şekillenme, postop MR sürecini etkileyebilir....

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“…The natural reduction of MR due to the left ventricular recovery after AVR has been reported. 7) However, the studies were limited to patients with aortic stenosis (AS) in the majority of previous reports. 7,8) Ruel and coworkers 9) reported the risk factors of heart failure and persistent mitral regurgitation after AVR.…”

Section: Discussionmentioning

confidence: 99%

“…7) However, the studies were limited to patients with aortic stenosis (AS) in the majority of previous reports. 7,8) Ruel and coworkers 9) reported the risk factors of heart failure and persistent mitral regurgitation after AVR. In their report, they considered an FMR greater than grade 2" and a left atrial diameter over 5 cm, a preoperative peak aortic valve gradient less than 60 mmHg, or atrial fibrillation were risk factors for CHF and persistent mitral regurgitation after AVR in AS patients, while an FMR greater than grade 2" and a left ventricular end-systolic diameter less than 45 mm were risk factors in AR patients.…”

Section: Discussionmentioning

confidence: 99%

Papillary Muscle Head Approximation for the Treatment of Mitral Valve Regurgitation Combined With Aortic Valve Disease

et al. 2010

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SummaryWe initiated an original papillary muscle head approximation procedure, commonly known as Sandwich plasty, for the treatment of ischemic mitral regurgitation (MR). In this study, we evaluated the appropriateness of this procedure for functional MR associated with aortic valve disease. Fifteen patients who had undergone Sandwich plasty combined with aortic valve surgery were included in this study. The mean age of the patients was 69 years. Predominant aortic valve diseases were regurgitation in 8 patients and stenosis in 7 patients. Aortic valve replacement was performed in 14 patients and David surgery in one. The mitral valve was approached through the aortic annulus in 9 patients (the transaortic group). Six other patients with mitral valve annulus of 30 mm or larger underwent concomitant mitral ring-annuloplasty through a left atrial incision (the LA group). The tenting height of the mitral valve and left ventricle diastolic diameter significantly decreased after surgery in both groups. After surgery, residual moderate or mild MR was detected in two patients in the transaortic group. In the LA group, residual mitral regurgitation was not detected. In the follow-up study, prominent MR occurred in two patients in the transaortic group. The MR free rate two years after surgery was 83% in the total patient population. Sandwich plasty was simple and effective in the treatment of functional mitral regurgitation combined with aortic valve surgery. A transaortic approach is effective in obviating a separate left atriotomy and reducing operation time. (Int Heart J 2010; 51: 47-50)

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Factors determining early improvement in mitral regurgitation after aortic valve replacement for aortic valve stenosis: A transthioracic and transesophageal prospective study

Cited by 49 publications

References 14 publications

Effects of Valve Replacement for Aortic Stenosis on Mitral Regurgitation

Effects of Valve Replacement for Aortic Stenosis on Mitral Regurgitation

Effect of Aortic Valve Replacement, for Aortic Stenosis, on Concomitant Mitral Valve Regurgitation

Papillary Muscle Head Approximation for the Treatment of Mitral Valve Regurgitation Combined With Aortic Valve Disease

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