Moderate secondary mitral insufficiency when repairing aortic valve: long-term results

Abstract

Objective. The purpose of our study was to evaluate long-term results after repair of aortic valve disease with moderate secondary mitral insufficiency (MI) and with and without correction of functional mitral regurgitation (MR), as well as to identify the predictors of mortality and recurrent MR in the long-term period.
Methods. The study included 234 patients with aortal disease combined with moderate secondary MR. The patients were divided into 2 groups: group I – aortal valve repair without MR correction (n = 113) and Group II – aortal valve repair with mitral annuloplasty (n = 121). The overall follow-up was 976 patient-years (1 to 10.8 years), the average one was 4.35 years.
Results. At discharge there was insignificant residual MR in 8% (9) patients in Group I and 3% (4) in group II. Hospital mortality was 4.6±2.0% (5) vs 5.8±2.1% (7) (p = 0.77). Survival after 1, 5 and 10 years in the group without MR correction was 95±6%, 76±10%, 58±20% respectively, while in the group with MR correction it came to 90±6%, 77±10%, 62±24% respectively (p = 0.72). No significant differences were noted after application of “propensity score matching” (p = 0.524). In general, a complicated early postoperative period with the development of a multiple organ dysfunction syndrome and initial pronounced hypertrophy with myocardial mass index more than 275 g / m² could be considered as predictors of long-term mortality. The freedom from MR in up to 10 years was 64% in Group I and 84% in Group II. Most patients had heart failure Class I-2 NYHA, 70 and 78.5% respectively. A hemodynamic type of the aortic disease did not affect the survival (p = 0.36) and rate of return of MR (p = 0.37), but there were different predictors of return to mitral regurgitation.
Conclusion. 92% of patients undergoing isolated aortic valve repair develop a mild MR at discharge. Persistent MR in the late period was observed in 64% of patients. Patients with moderate secondary MR who underwent mitral annuloplasty had high efficiency in the long term (84%), however, it had no effect on mortality and morbidity both in the early and long-term periods. Despite the absence of significant difference in survival between the two groups, the group with the corrected MR showed lesser clinical manifestations of chronic heart failure and more pronounced return heart remodeling processes.