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Do we have to operate on moderate functional mitral regurgitation during aortic valve replacement for aortic

Adam R Kowalówka1, Magdalena Onyszczuk2, Wojciech Wańha3

  • 1Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland adam.kowalowka@orange.pl.

Interactive Cardiovascular and Thoracic Surgery
|July 6, 2016
PubMed

Insights

For moderate functional mitral regurgitation during aortic valve replacement for aortic stenosis, conservative treatment is often effective. Surgery is recommended for moderate-severe or severe cases, especially with deterioration predictors.

Area of Science:

  • Cardiac Surgery
  • Cardiology
  • Clinical Evidence Synthesis

Background:

  • A best evidence topic addressed whether to operate on moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) for aortic stenosis (AS).
  • A systematic search identified 325 papers, with 9 selected for best evidence analysis.
  • The study aimed to clarify surgical strategies for FMR in patients undergoing AVR for AS.

Observation:

  • Significant predictors of improved outcomes included lower preoperative mitral regurgitation and better left ventricle fractional area change.
  • Predictors of deterioration included persistent atrial fibrillation, enlarged left atrium, increased left ventricular mass, pulmonary hypertension, and a peak aortic valve gradient <60 mmHg.
  • A general trend showed improvement or non-progression of FMR after AVR for AS.

Findings:

  • Conservative management of FMR showed improvement in 45-95% of cases, with 19-38% unchanged and 1-14% deterioration.
  • Surgical treatment of FMR resulted in improvement in 46-69%, 34-53% unchanged, and 10% deterioration.
  • Moderate or less FMR without deterioration predictors can be treated conservatively; moderate-severe and severe FMR warrant surgical intervention.

Implications:

  • Current evidence supports conservative management for moderate FMR without adverse predictors during AVR for AS.
  • Surgical intervention for FMR is advised for moderate-severe and severe cases, particularly those with identified deterioration risks.
  • Further randomized controlled trials are needed to definitively guide surgical strategies for FMR in AS patients.
Keywords:
Aortic stenosisAortic valve replacementFunctional mitral regurgitationReview

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