Quantitative evaluation of change in coexistent mitral regurgitation after aortic valve replacement

Abstract

Objective Management of intermediate degrees of mitral regurgitation (MR) during aortic valve replacement (AVR) for aortic stenosis remains controversial. We sought to evaluate the degree of reduction of MR in patients undergoing AVR, as well as the relationship between the pre-operative gradient across the aortic valve and the degree of reduction in MR. Methods We retrospectively analyzed demographic, intraoperative, and echocardiographic data on 802 patients that underwent AVR or aortic root replacement between January 2010 and March 2011. 578 patients underwent AVR or aortic root replacement without intervention on the mitral valve. We excluded 88 patients with severe aortic insufficiency, 3 patients that underwent ventricular assist device placement, 4 patients that underwent prior mitral valve replacement, and 21 patients with incomplete data yielding 462 patients for analysis. MR was graded for each patient and the degree of change in MR for each patient was determined by subtracting the grade of pre-operative MR from the degree of post-operative MR. Results Of the 462 patients, 289 patients had at least mild MR. On average, MR was downgraded by 0.24 degrees per patient for this cohort of 289 patients. Of the 56 patients with at least moderate MR, MR was downgraded 0.54 degrees per patient. Of 62 patients that underwent AVR only, had at least mild MR, and no evidence of structural mitral valve disease, downgrading of MR was 0.24 degrees per patient. Linear regression analysis revealed no relationship between reduction in MR and pre-operative gradient across the aortic valve. Conclusions Reduction in MR after relief of aortic outflow tract obstruction is modest at best. Further, the magnitude of the pre-operative gradient across the aortic valve has little influence on the degree of reduction in MR. These observations argue in favor of performing a prospective evaluation of the clinical benefits of addressing moderate MR at the time of aortic valve intervention.

Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry

“…Besides such findings, however, we confirmed here that the co-existence of moderate to severe mitral regurgitation also impacted early survival in the surgical cohort, thus fueling the recent highly debated need for concomitant mitral surgery during AVR. 12 Female sex in AVR patients also proved an independent predictor of intraprocedural/postprocedural transfusions, despite the absence of differences in major vascular complications. The detrimental impact of perioperative transfusions on outcome in the surgical population has been well ascertained.…”

Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement

“…Seventy-eight percent of the TAVR patients had no MR or less than moderate MR at baseline. It is known that these patients show little regression or progression after TAVR [40,41]. On the other hand our study showed more improvement in subjects with higher MR grade before intervention (63%).…”

The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

“…After completing the literature search protocol, 27 studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] with the total of 4452 patients were found to meet the inclusion criteria and were included in the analysis following thorough assessment ( Figure 1 ).…”

“…Out of these, 23 studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 ] (n = 2497) contained specific data about MR before and after surgery. Three publications [ 20 , 21 , 37 ] reported only mortality and survival data and one [ 32 ] was specific about pre and postoperative mitral anulus dimensions.…”