Management of moderate secondary mitral regurgitation at the time of aortic valve surgery†

OBJECTIVES: To define the impact of surgical strategy [concomitant mitral valve surgery or isolated aortic valve replacement (AVR)] in patients with moderate secondary mitral regurgitation (MR) at the time of AVR. METHODS: From January 1999 to December 2009, 3339 patients underwent AVR of whom 255 had secondary MR>2+ and constituted the study population. Patients were stratified into two groups, with (Group A, n = 94, 36.8%) and without concomitant mitral valve surgery (Group B, n = 161, 63.2%). Follow-up up to 12 years (1076 patient-years) was analysed for survival, valve-related events and per-sistent MR. Predictors of late mortality and persistent MR were further analysed. A case-match analysis [age, gender, New York Heart Association (NYHA) and left ventricular ejection fraction] was performed, excluding patients with coronary artery disease (CAD). RESULTS: The mean age of the population was 67.0 ± 11.7 years, 63.5 % male and 64.7 % in NYHA III–IV. Group B patients were signifi-cantly older and had higher incidence of coronary disease, hypertension and mitral calcification. They also had a higher ejection frac-tion and transaortic gradients, and lower MR grade (mean MR: 2.8 vs 3.2) and pulmonary artery pressure. Mitral surgery consisted mainly of annuloplasty procedures (96%). Only 2 patients from the entire cohort were reoperated on/for the mitral valve. Thirty-day mortality rate was 0.3%. There was no difference in long-term survival and valve-related complications, even after case-matched ana-lysis. CAD, history of cerebrovascular accident, permanent atrial fibrillation, renal failure and persistence of MR emerged as independ-ent predictors of late mortality (P < 0.05). MR improved in 67.4 % of patients from Group B against 82.3 % from Group A (P = 0.011)