Background Mitral regurgitation (MR) is common in patients with degenerative aortic valve disease. Though the natural history following aortic valve replacement (AVR) of significant MR is known, that of normal or nearly normal mitral valve function is uncertain.
Methods One hundred and forty-seven patients who had AVR and [139}2+ MR (on a 1-4 scale) on a preoperative echocardiogram were followed up for a mean of 489 days with a second echocardiogram. Patient characteristics: age 63[138}13 years, 69% male, EF 50±16%, 65% had CABG. Reason for AVR was severe aortic stenosis in 54% and mixed aortic valve disease in the rest. Development of 3 or 4+ MR in the intermediate term follow-up was related to clinical, operative and echocardiographic variables.
Results On the follow-up echocardiogram 3 or 4+ MR developed in 1 (2%) of the 44 patients with no preoperative MR, 8 of the 54 (15%) patients with 1+ preoperative MR and 16 (33%) of the 49 patients with 2+ preoperative MR. Risk factors for the development of 3-4+ MR included female gender (p=0.05), greater age (68±11 vs 62±14 years, p=0.03), presence of left main disease (24 vs 10%, p=0.05) and greater degree of preoperative MR (grade 1.6±0.6 vs 0.9±0.8, p≤0.0001). Reduction in LV size (p=0.08) following AVR was marginally protective.
Conclusions 1) Significant (3-4+) MR may develop de novo over an intermediate term follow-up in up to 33% of patients undergoing AVR. 2) Risk factors for its development include female gender, older age, presence of left main disease and greater degrees of preoperative MR. 3) Precise mechanism of its genesis, medical and surgical strategies to its prevention need further investigation.
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