Impact of mild-moderate mitral regurgitation on outcomes of isolated aortic valve replacement
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KeywordsAortic Stenosis Mitral Regurgitation Aortic Valve Replacement Aortic Regurgitation Mitral Regurgitation Severity
The impact of mitral regurgitation (MR) severity on patients undergoing aortic valve replacement (AVR) for aortic stenosis remains unclear.
This study evaluated the effects of mild or moderate MR on outcomes of isolated AVR for aortic stenosis.
Clinical outcomes evaluated were postoperative complications; length of stay in intensive care unit (ICU); 30-day and late mortality; and the degree of MR improvement on echocardiograms after AVR. MR severity was defined according to the European Association of Echocardiography recommendations. Medium-term functional outcome was assessed using the Short Form-36 quality of life (QoL) questionnaire.
Eighty-nine patients received isolated AVR for significant aortic stenosis from August 2008 to September 2014, of which 53 patients had co-existing mild MR while 36 had moderate MR. Both groups were similar prior to surgery, except in the incidence of concomitant aortic regurgitation (28% versus 17%). Median follow-up time for postoperative echocardiograms and QoL assessment were 1 and 3 years respectively.
The odds of postoperative complications were greater in the moderate MR patients although this may have been a chance observation (OR, 2.3; p = 0.3). Mild MR patients had fewer postoperative complications (mean of 2 ± 2 versus 3 ± 3 complications; p = 0.04). There was no significant difference in the odds of mean duration of ICU-stay (mean 3 ± 3 versus 4 ± 4 days; p = 0.4) or 30-day mortality between groups (OR, 1.6; p = 0.5). Difference in late-mortality was insignificant (HR, 1.2; P = 0.5). Based on available postoperative echocardiograms, mild MR (n = 37) worsened in MR grade by 0.1 ± 0.5 whereas moderate MR (n = 27) improved by 0.4 ± 0.6 in MR grade after AVR (p = 0.01). Fewer patients with mild MR made an improvement in MR grade postoperatively (27% versus 59%). Only 79% and 72% of the patients in mild and moderate MR groups respectively were alive at the time of survey. At follow-up, both groups had similar QoL.
Clinical and medium-term functional outcomes were similar in patients with mild or moderate MR undergoing isolated AVR.
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