Fate of functional mitral regurgitation and predictors of persistent mitral regurgitation after isolated aortic valve replacement.

Abstract

BACKGROUND: There are no clear guidelines in regard to optimal management of functional mitral regurgitation (MR) in patients undergoing aortic valve replacement (AVR). This study evaluated changes in functional MR and determined predictors of persistent MR after isolated AVR.

METHODS: We retrospectively reviewed 118 consecutive patients with functional MR at the time of isolated AVR from January 2000 to December 2009. We collected preoperative and postoperative echocardiographic data to determine the degree of change in MR after AVR. Patients were divided into those without (n=71) and those with persistent MR (n=42). Late follow-up echocardiography was completed in 95% (113/118) of patients. The mean follow-up duration was 56.7±35.3 months.

RESULTS: Mitral regurgitation improved in 72% (81/113), was unchanged in 25% (28/113), and worsened in 3% (4/113) of patients. There were no differences in 10-year survival rates among groups based on preoperative MR status (grade I, 93.1%; grade II, 85.4%; grade III, 80%; p=0.432). However, there was a significant difference in postoperative survival between patients without and with persistent MR (93.1% versus 77.8% respectively, p=0.036). Predictors of persistent MR by univariate analysis included higher left ventricular ejection fraction (LVEF), higher right ventricular (RV) systolic pressure, decreased left ventricular end systolic dimension (LVESD), and decreased left ventricular end diastolic dimension (LVEDD). In multivariate analysis, only RV systolic pressure was identified as an independent risk factor predicting persistent MR (p=0.035; odds ratio [OR], 1.037; confidence interval [CI], 1.003 to 1.072).

CONCLUSIONS: Functional MR improved in most patients after AVR alone. Postoperative persistent MR affects long-term survival in functional MR. Preoperative RV systolic pressure is an independent risk factor predicting persistent MR.