K. YIN1,2, Y. Lin1, Z. Zhang1, C. Wang1 1Zhongshsn Hospital of Fudan University,Department Of Cardiac Surgery,Shanghai, SHANGHAI, China 2Harvard T.H.Chan School Of Public Health,Boston, MA, USA
Introduction:
The optimal management strategy of moderate functional mitral regurgitation among severe aortic insufficiency patients who underwent aortic valve surgery is still not well-defined. We aimed to evaluate and compare the clinical outcomes between three mitral valve treatment strategies: valve repair, valve replacement, and no intervention.
Methods:
From January 2010 to October 2014, 136 consecutive patients (age 54.5 ± 12.4 years, male 77.2%) who underwent aortic valve procedure for severe aortic insufficiency with coexisting moderate mitral regurgitation were evaluated. Seventy-one patients (52.2%) received concomitant mitral valve repair, 11 patients (8.1%) underwent mitral valve replacement, and the other 54 patients (39.7%) received no intervention. The mean follow-up time was 38.2 ± 22.6 months with a completeness of follow-up of 97%. Demographic, echocardiographic and operative data were reviewed. Follow-up valve function and survival time were also compared between groups.
Results:
Mitral valve repair or replacement procedures were associated with longer aortic cross-clamp time and cardiopulmonary bypass time. There was no significant difference between three groups in regards of ICU and hospital stay, transfusion rate, in-hospital mortality, 1-year, 3-year and 5-year survival, and post-operative NYHA function classes. During follow-up, 16.7% (9/54) in the no intervention group patients developed moderate to severe residual mitral regurgitation, while no patient in the mitral repair and replacement groups had residual regurgitation. Patients with moderate or more residual mitral regurgitation had larger preoperative left atrium size (45.7 ± 5.9 vs 40.1 ± 6.3 mm, p = 0.03).
Conclusion:
Intervention of moderate functional mitral regurgitation in patients with severe aortic insufficiency adds no extra benefits in regards of post-operative recovery, NYHA function class and survival. Dilated left atrium is a risk factor of residual mitral regurgitation and may require concomitant mitral intervention.