Change in mitral regurgitation severity after aortic valve replacement for aortic stenosis

Brasch, Andrea V.; Khan, Steven S.; DeRobertis, Michele; Kong, Jonathan H.K; Chiu, Josephine; Siegel, Robert J.

doi:10.1016/s0002-9149(00)00746-3

Cited by 46 publications

(50 citation statements)

References 7 publications

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“…2,[5][6][7][8][9][10][11][12][13] In addition, the timing of the postoperative echocardiographic examination varied markedly among studies, ranging from the early postoperative period 6,12 to 18 months after surgery. 5 To the best of our knowledge, the present study is the first to prospectively assess the magnitude of changes in the quantified degree of MR. After AVR, MR severity, as assessed by the ERO and the regurgitant volume, decreased in most patients, although it increased slightly in a minority of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the presence of concomitant structural mitral valve abnormalities, MR has been linked to various geometric and hemodynamic changes. Preoperatively, the following parameters have been shown to be associated with a decrease in severity of MR: LV mass, 11,12 LV function, 9 left atrial diameter, 5 and the degree of MR. 7 In the present study, only the preoperative severity of MR and the extent of mitral valvular deformation as assessed by the coaptation height emerged as independent predictors of postoperative improvement in MR. Only parameters with a value of p Ͻ0.10 are presented. Unlike several previous reports 6,13 that described a larger surgery-induced improvement in MR in patients with functional MR, whether MR was functional or not in the present study was not predictive of improvement in MR.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…14 However, the magnitude of MR improvement seems greater with higher degrees of preoperative MR, and postoperative MR aggravation is rare. Because of the preoperative functional role of MR, it could be reasonable to consider concomitant mitral valve surgery only in patients whose MR severity is confirmed using an echocardiographic method that is less dependent on loading conditions than the measurement of color Doppler mitral jet area, such as the width at the origin of the regurgitant jet, or the study of the proximal isovelocity surface area.…”

Section: Discussionmentioning

confidence: 99%

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

Tassan-Mangina

Metz

Nazeyrollas

et al. 2003

Clinical Cardiology

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SummaryBackground: Mitral regurgitation (MR) is frequently associated with aortic stenosis. Previous reports have shown that coexisting mitral insufficiency can potentially regress after aortic valve replacement.Hypothesis: This study sought to assess the frequency and severity of MR before and after aortic valve replacement for aortic stenosis and to define the determinants of its postoperative evolution.Methods: For this purpose, 30 adult patients referred for aortic valve surgery underwent pre-and postoperative transthoracic and transesophageal echocardiography and color Doppler examination.Results: Mean preoperative left ventricular ejection fraction was 57 ± 16% and remained unchanged postoperatively. Preoperative MR was usually mild to moderate and correlated with aortic stenosis severity and left ventricular systolic dysfunction. The color Doppler mitral regurgitant jet area significantly decreased during the postoperative period (p = 0.016) as left ventricular loading conditions returned to normal, suggesting an early decrease of the functional part of MR. On the other hand, the mitral regurgitant jet width at the origin remained unchanged. Statistical analysis found pulmonary artery pressure (p = 0.02) and indexed left ventricular mass (p = 0.009) to be preoperative predictive factors of postoperative MR improvement. Predictive factors of postoperative MR severity were left atrial diameter (p = 0.02), pulmonary artery pressure (p = 0.003), and the presence of mitral calcifications (p = 0.004).

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“…In light of these findings and of the incremental operative risk associated with concomitant mitral valve procedures, 4 some surgeons choose to perform isolated AVR and avoid mitral valve repair or replacement in patients with severe AS and concomitant moderate SMR. 5,6 The mechanisms for SMR improvement after AVR for AS are related to several factors, including decrease in LV afterload, resulting in lower LV systolic pressures and MR driving forces. The relief of LV pressure overload achieved by AVR is also associated with regression of LV remodeling and hypertrophy, which may improve coaptation of the mitral valve leaflets.…”

Section: Clinical Perspective On P 42mentioning

confidence: 99%

Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis

Angeloni

Melina

Benedetto

et al. 2012

Circ: Cardiovascular Imaging

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Background-Secondary mitral regurgitation (SMR) is generally reduced after isolated aortic valve replacement (AVR), but there is important interindividual variability in the magnitude of this reduction. Prosthesis-patient mismatch (PPM) may hinder normalization of left ventricular geometry and pressure overload following AVR, therefore we aimed to investigate the relationship between PPM and regression of SMR following AVR for aortic valve stenosis. Methods and Results-A total of 419 patients with AS who underwent isolated AVR at 2 institutions and presenting moderate SMR (mitral regurgitant volume 30 to 45 mL/beat) not considered for surgical correction were included in this study. Clinical and echocardiographic follow-up were completed at a median follow-up time of 37 months. PPM was defined as an indexed effective orifice area Յ0.85 cm 2 /m 2 and was found in 170/419 patients (40.6%). There were no significant differences in baseline and operative characteristics between patients with or without PPM. Patients with PPM had less regression of SMR following AVR compared with those with no PPM (change in mitral regurgitant volume:Ϫ11Ϯ4 versus Ϫ17Ϯ5 mL, respectively; PϽ0.0001). Variables significantly associated with postoperative change in mitral regurgitant volume on univariable analysis were entered in a multivariable linear regression model, which showed indexed effective orifice area (PϽ0.0001) and left atrial diameter (Pϭ0.006) to be independently associated with mitral regurgitant volume improvement. Patients with PPM also had less postoperative improvement in 6-minute walking test distance (80Ϯ78 versus 42Ϯ41 m, PϽ0.0001). Conclusions-PPM is associated with lesser regression of SMR following AVR. This unfavorable effect was associated with worse functional capacity. These findings emphasize the importance of operative strategies aiming to prevent PPM in patients with aortic valve stenosis and concomitant SMR. (Circ Cardiovasc Imaging. 2012;5:36-42.)

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Change in mitral regurgitation severity after aortic valve replacement for aortic stenosis

Cited by 46 publications

References 7 publications

Effects of Valve Replacement for Aortic Stenosis on Mitral Regurgitation

Effects of Valve Replacement for Aortic Stenosis on Mitral Regurgitation

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

Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis

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