Management of concomitant mild to moderate functional mitral regurgitation during aortic valve surgery for severe aortic insufficiency.

Abstract

The optimal management of mild to moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) for severe aortic insufficiency (AI) is poorly defined. We aimed to investigate the fate of FMR after AVR with or without concomitant mitral annuloplasty (MAP) and to identify the risk factors and clinical implications of persistent FMR. Between June 1996 and August 2011, 155 patients with mild to moderate FMR undergoing AVR for severe AI were reviewed. The preoperative MR grade was mild in 101 patients (65%) and moderate in 54 patients (35%). Persistent FMR was defined as MR grade remaining the same or increased on the last follow-up echocardiogram. The mean follow-up duration was 4.5 ± 3.9 years. FMR improved in 88% of the patients. On multivariate analysis, left ventricular end-diastolic dimension (LVEDD) reduction after AVR was identified as the only predictor for FMR improvement (P = .004; hazard ratio, 0.927; confidence interval, 0.881 to 0.977). Concomitant MAP did not show additional benefit in preventing persistent FMR (P = .35). Although no survival difference was observed between the patients with and without persistent FMR (P = .78), persistent FMR was associated with greater heart failure events (P < .001). Mild to moderate FMR as a result of severe AI improved with AVR in most patients with or without concomitant MAP. Poor postoperative LVEDD reduction was the only risk factor for persistent FMR. Because persistent FMR tended to be associated with heart failure events, close echocardiographic monitoring and proactive medical management are recommended in patients showing poor LVEDD reduction after AVR.