Prognosis of functional mitral regurgitation after aortic valve replacement for pure severe aortic stenosis

Abstract

Objective Whether patients with severe aortic stenosis (AS) and significant functional mitral regurgitation (MR) should undergo isolated aortic (aortic valve replacement [AVR]) or double aortic‐mitral valve procedure (DVP) remains controversial. We sought to determine outcomes of such patients undergoing surgical (surgical aortic valve replacement [SAVR]) and transcatheter AVR (TAVR) or DVP, identify echocardiographic parameters predictive of significant residual MR after isolated AVR, and determine its impact on long‐term survival. Methods Data prospectively collected from 736 consecutive patients with severe AS and significant MR undergoing AVR or DVP were retrospectively analyzed. Exclusion of organic MR, other valve diseases and concomitant CABG yielded a final population of 74 patients with significant functional MR (32 TAVR, 23 SAVR, 19 DVP). Demographics, postoperative complications and age‐adjusted survival were compared. Echocardiographic predictors of significant residual MR and its impact on survival were analyzed for patients undergoing isolated AVR. Results In the isolated AVR group, MR improvement occurred in 60% of patients and was associated with a significant increase in survival compared to persistence of significant MR (p = .03). Patients with improved MR had significantly greater preoperative left ventricular dilatation (LVEDD: 49 vs. 43 mm, p = .001; LVESD: 35 vs. 29 mm, p = .03; LVEDV: 101 vs. 71 ml, p = .0003; LVESV: 57 vs. 33 ml, p = .002). There was no significant difference in perioperative mortality (5.3 vs. 4.4 vs. 9.4%, p = .85) or age‐adjusted long‐term survival between isolated AVR and DVP groups (76.3 vs. 84.2% survival at 2‐year follow‐up, p = .26), or between SAVR, TAVR and DVP groups (78.2 vs. 75.0 vs. 84.2% survival at 2‐year follow‐up, p = .13). Conclusions After isolated AVR, MR improvement occurs in 60% of patients. It is predicted by greater ventricular dimensions and associated with significantly better long‐term survival. Whether a staged approach with transcatheter correction of MR should be considered in patients with significant residual MR following AVR remains undetermined.

Residual mitral regurgitation following isolated aortic valve replacement

“…To the Editor, Therapeutic strategy for those with severe aortic stenosis and functional mitral regurgitation remains controversial. Voisine et al 1 demonstrated that mitral regurgitation improved in 60% of patients following the isolated aortic valve replacement. Improvement in mitral regurgitation was associated with baseline greater left ventricular dimension and better long-term survival.…”

“…The authors found several baseline echocardiographic characteristics associating with the postprocedural improvement in mitral regurgitation. 1…”

“…The authors assessed the improvement in mitral regurgitation using the latest available echocardiograms following the aortic valve replacements. 1 Detailed timing of the echocardiographic assessments would be informative. Improvement in mitral regurgitation is achieved soon after the procedure or can be achieved even after several years?…”

Change in mitral regurgitation severity after transcatheter aortic valve replacement in patients with severe mitral regurgitation

“…To the Editor, We read with great interest the recent article by Voisine et al 1 concerning the effect of isolated aortic valve replacement (AVR) on concomitant mitral regurgitation (MR) and its impact on mortality. As summarized in the article, MR has been improved in 60% of patients who underwent isolated AVR, which was associated with better longterm survival.…”

Response—Letter to the editor "Change in Mitral Regurgitation Severity after Transcatheter Aortic Valve Replacement in Patients with Severe Mitral Regurgitation"

“…We would like to thank Dr. Wei, Dr. Liu, and Dr. Guo for taking interest in our study “Prognosis of Functional Mitral Regurgitation after Aortic Valve Replacement for Pure Severe Aortic Stenosis” 1 and for contributing to this discussion.…”