Abstract
Objective
Deterioration of the native aortic valve function by a late progression of rheumatic
disease is not infrequent in patients who underwent rheumatic mitral valve surgery;
however, this phenomenon has not been clearly quantified.
Methods
A total of 1155 consecutive patients (age 52.0 ± 12.9 years; 807 female) who underwent
rheumatic mitral valve surgery without concomitant aortic valve surgery from 1997
to 2015 were enrolled. The primary end point was the composite of progression to severe
aortic valve dysfunction or a requirement of subsequent aortic valve replacements
during follow-up. To determine the risk factors of the primary outcome, we performed
the generalized linear mixed model.
Results
The baseline severities of aortic valve were none to trivial in 880 patients (76.2%),
mild in 256 patients (22.2%), and moderate in 19 patients (1.6%). The latest 1062
echocardiographic assessments (91.9%; median, 81.2 postoperative months; interquartile
range, 37.3-132.1 months) demonstrated 26 cases (0.33%/patient-year) meeting the primary
end point during follow-up. Cumulative incidence of the primary end point at 10 years
was 0.4% ± 0.3% and 7.4% ± 2.5% depending on the presence of mild or greater aortic
valve dysfunction at baseline (P < .01). In multivariable analyses, aortic valve peak pressure gradient (odds ratio,
1.14; 95% confidence interval, 1.10-1.20), aortic regurgitation degree (mild over
none: odds ratio, 3.26; 95% confidence interval, 1.15-9.23), and time (odds ratio,
1.30; 95% confidence interval 1.19-1.41) were significantly associated with the occurrence
of the primary end point.
Conclusions
Progression of severe aortic valve dysfunction and the need for aortic valve replacement
are uncommon in patients undergoing rheumatic mitral valve surgery. However, such
events were relatively common among those with mild or greater aortic valve dysfunction
at the time of mitral valve surgery.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
AR (aortic regurgitation), AS (aortic stenosis), AV (aortic valve), AVD (aortic valve dysfunction), AVR (aortic valve replacement), CI (confidence interval), MV (mitral valve), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 18, 2021
Accepted:
March 8,
2021
Received in revised form:
February 24,
2021
Received:
July 15,
2020
Footnotes
Institutional Review Board approval number: Institutional Review Board of Asan Medical Center (No. 2020-0875), May 7, 2021.
Identification
Copyright
© 2021 by The American Association for Thoracic Surgery
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