류마티스성 승모판막 수술 시 동반된 경도 또는 중등도 대동맥판막 질환의 장기 추적관찰

Abstract

Background and Objectives : A considerable proportion of patients who require mitral valve (MV) replacement present with a coexisting pathology of the aortic valve (AV). However, combined AV and MV replacement is associated with increased operative risk and lower long-term survival rates than MV replacement (MVR) alone. Little is known concerning the natural history of AV disease in patients undergoing MV surgery. The purpose of this study was to analyze the long-term clinical outcome and requirements for subsequent AV replacement (AVR) in patients with mild to moderate AV disease at the time of MV surgery. Materials and Method: One hundred forty-one patients (97 female, mean age 43 years) with mild to moderate AV disease and severe rheumatic MV disease were treated with MV surgery. The patients were followed for an average period of 8±3 years (range 1-16) following MV surgery. Primary outcomes (death and subsequent AVR) were evaluated. Results: At the time of MV surgery, 104 patients (73.8%) had mild aortic regurgitation (AR), 37 patients (26.2%) moderate AR, 5 patients (3.5%) mild aortic stenosis (AS) and 2 patients (1.4%) moderate AS. At the end of the follow-up period only one patient had severe AR. Eight patients (5.7%) died during the follow-up, and four patients (2.8%) were treated with AVR after a mean period of 9 years. A survival analysis with using the Kaplan-Meier method revealed a 10-year survival rate of 95.5% and a 10-year event free survival rate of 93.6%. Conclusion: In most patients with mild to moderate rheumatic AV disease at the time of MV surgery, subsequent AVR is rarely required after a long follow-up period. This data may support a decision not to recommend prophylactic AVR at the time of MV surgery in these patients.