Mitral valve repair versus replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement

Abstract

OBJECTIVES: Whether to repair or replace the mitral valve for patients with significant mitral regurgitation undergoing aortic valve replacement is still controversial. METHODS:From January 1990 to December 2011, a total of 663 patients underwent aortic valve replacement combined with mitral valve surgery. Among these, 253 patients (mean age 55.9 ± 14.5 years, 91 females) with moderate-to-severe mitral regurgitation were enrolled to compare the outcomes between double valve replacement (DVR group, n = 158) and aortic valve replacement plus mitral valve repair (AVR plus MVr group, n = 95). Survival and valve-related events were compared by the inverse-probability-treatment-weighted method using propensity scores to reduce treatment selection bias. RESULTS:Early mortality was similar between the groups (1.9% in the DVR group when compared with 3.2% in the AVR plus MVr group, P = 0.55). During the mean follow-up period of 72.1 ± 56.7 months, 45 patients died (28 in DVR and 17 in AVR plus MVr) and 31 experienced valve-related events including valve reoperation in 11, anticoagulation-related bleeding in 14, thromboembolism complications in 9 and infective endocarditis in 3. After adjustment for baseline risk profiles, the DVR group showed no difference with regard to risks of death (hazard ratio [HR], 1.79; 95% confidence interval [CI], 0.79-4.01; P = 0.16) and valve-related events (HR, 1.15; 95% CI, 0.40-3.30; P = 0.80) compared with the AVR plus MVr group. CONCLUSIONS:Although the outcomes of either mitral valve repair or replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement show no statistical significance in terms of long-term survival and valve-related event rates, DVR seems more hazardous than AVR plus MVr based on the estimated HR in terms of survival.

Surgery for mitral regurgitation in patients with aortic root aneurysm: Transaortic or transseptal approach?

“…Firstly, bileaflet mechanical aortic valves were implanted in all patients in the current study, which made the incidence of thrombosis, anticoagulation related complications and endocarditis was similar in the two groups. Secondly, the previous study suggested that the outcomes of either mitral valve repair or replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement had no statistical significance in terms of long-term survival and valve-related event rates [18]. The similar in-hospital outcomes could be observed at our institute.…”

Surgical Decision-Making in Multivalvular Heart Disease: A Holistic Approach

“…Various prospective and retrospective studies advocate better long-term outcome for patients with mitral valve repair with concomitant aortic valve replacement over double valve replacement. [1][2][3] McGonigle et al in a retrospective analysis confirmed significant benefit in survival postsurgery, following either technique. 4 Postoperative complications like bleeding, reoperations, infective endocarditis, and thromboembolic events have similar incidence among the two surgical techniques.…”

Survival and long-term outcomes after concomitant mitral and aortic valve replacement in patients with rheumatic heart disease

“…They included patients with all aetiologies and their study involved multiple operators. Despite these favourable early outcomes, they concluded DVR to be more hazardous than AVR with concomitant mitral valve repair based on long-term survival [ 5 ].…”