Treatment of Moderate Functional Mitral Regurgitation during Aortic Valve Replacement: A Cohort Study

TL;DR

This study compares surgical strategies for treating moderate functional mitral regurgitation during aortic valve replacement and finds that isolated aortic valve replacement may be preferable.

Contribution

The study provides new evidence on the outcomes of different surgical approaches for moderate functional mitral regurgitation during aortic valve replacement.

Findings

AVR + MVR improved functional mitral regurgitation more than isolated AVR or AVR + MVr.

AVR + MVR increased mid-term mortality risk compared to isolated AVR.

Isolated AVR may be more reasonable than combined procedures for moderate FMR.

Abstract

Treatment of moderate functional mitral regurgitation (FMR)
during aortic valve replacement (AVR) is controversial. This study aimed to
evaluate the effect of different surgical strategies in patients with moderate
FMR undergoing AVR.

A total of 468 patients with moderate FMR
undergoing AVR from January 2010 to December 2019 were retrospectively studied
comparing 3 different surgical strategies, namely isolated AVR, AVR + mitral
valve repair (MVr) and AVR + mitral valve replacement (MVR). Survival was
estimated using the Kaplan-Meier method and compared with the log-rank test,
followed by inverse probability treatment weighting (IPTW) analysis to adjust the
between-group imbalances. The primary outcome was overall mortality.

Patients underwent isolated AVR (35.3%), AVR + MVr (30.3%),
or AVR + MVR (34.4%). The median follow-up was 27.1 months. AVR + MVR was
associated with better improvement of FMR during the early and follow-up period
compared to isolated AVR and AVR + MVr (p < 0.001). Compared to
isolated AVR, AVR + MVR increased the risk of mid-term mortality (hazard ratio
[HR]: 2.13, 95% confidence interval [CI]: 1.01–4.48, p = 0.046), which
was sustained in the IPTW analysis (HR: 4.15, 95% CI: 1.69–10.15, p =
0.002). In contrast, AVR + MVr showed only a tendency to increase the risk of
follow-up mortality (HR: 1.63, 95% CI: 0.72–3.67, p = 0.239), which
was more apparent in the IPTW analysis (HR: 2.54, 95% CI: 0.98–6.56, p
= 0.054).

In patients with severe aortic valve disease and
moderate FMR, isolated AVR might be more reasonable than AVR + MVr or AVR + MVR.

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