Results of aortic valve replacement in aortic stenosis and moderate functional mitral regurgitation

Referral and admission echocardiography (ECHO) in patients scheduled for aortic valve replacement (AVR) with aortic stenosis (AS) may differ in the assessment of moderate functional mitral regurgitation (FMR).

Our study aimed to determine truly moderate FMR and evaluate its impact on survival.

We conducted an observational study of patients referred for AVR with AS and no, mild, or moderate FMR between 2014 and 2019. Patients were assigned into three groups: (1) no/mild (N-FMR); (2) moderate-FMR on one ECHO (either at referral or on admission) termed incidental (I-FMR); (3) moderate FMR in two studies (both at referral and on admission) termed permanent (PM-FMR).

The referral and admission assessment were performed median 35 days apart. Of the 679 elective patients who underwent elective isolated AVR, 516 patients had N-FMR, 102 patients had I-FMR, and 61 patients had PM-FMR. Median follow-up was 46 months (22.5-58.5); max 73.3. Thirty-day mortality was 2.5% vs. 1% vs. 8.2% (N-FMR vs. I-FMR vs. PM-FMR, respectively; P = 0.01). Five-year survival was 84.1% in N-FMR vs. 88.5% in I-FMR vs. 60.6% in the PM-FMR group, where it was the lowest (P < 0.001). In multivariable modeling, PM-FMR increased mortality (hazard ratio [HR], 1.88 [1.05-3.37]; P = 0.03). I-FMR had no effect on mortality (HR, 0.67 [0.32-1.37]; P = 0.28). Five-year survival after excluding 30-day mortality was 86.3% vs. 89.4% vs. 66.0%; (N-FMR vs. I-FMR vs. PM-FMR, respectively; P = 0.02). PM-FMR increased late mortality (HR, 2.17 [1.14-4.15]; P = 0.01).

In patients undergoing isolated AVR for AS, the presence of permanent moderate FMR significantly impacts 30-day and mid-term survival.