Progression of Non-Significant Mitral and Tricuspid Regurgitation after Surgical Aortic Valve Replacement for Aortic Regurgitation.
Shirit KazumMordehay VaturiIdit YedidyaShmuel SchwartzenbergOlga MorelliKeren SkalskyHadas OfekRam SharonyRan KornowskiYaron ShapiraAlon ShechterPublished in: Journal of clinical medicine (2023)
Little is known about the natural history of non-significant mitral and tricuspid regurgitation (MR and TR) following surgical aortic valve replacement (SAVR) for aortic regurgitation (AR). We retrospectively analyzed 184 patients (median age 64 (IQR, 55-74) years, 76.6% males) who underwent SAVR for AR. Subjects with significant non-aortic valvulopathies, prior/concomitant valvular interventions, or congenital heart disease were excluded. The cohort was evaluated for MR/TR progression and, based on the latter's occurrence, for echocardiographic and clinical indices of heart failure and mortality. By 5.8 (IQR, 2.8-11.0) years post-intervention, moderate or severe MR occurred in 20 (10.9%) patients, moderate or severe TR in 25 (13.5%), and either of the two in 36 (19.6%). Patients who developed moderate or severe MR/TR displayed greater biventricular disfunction and functional limitation and were less likely to be alive at 7.0 (IQR, 3.4-12.1) years compared to those who did not (47.2 vs. 79.7%, p < 0.001). The emergence of significant MR/TR was associated with preoperative atrial fibrillation/flutter, symptomatic heart failure, and above-mild MR/TR as well as concomitant composite graft use, but not with baseline echocardiographic measures of biventricular function and dimensions, aortic valve morphology, or procedural aspects. In conclusion, among patients undergoing SAVR for AR, significant MR/TR developed in one fifth by six years, correlated with more adverse course, and was anticipated by baseline clinical and echocardiographic variables.
Keyphrases
- aortic valve
- aortic valve replacement
- aortic stenosis
- ejection fraction
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
- left ventricular
- heart failure
- atrial fibrillation
- contrast enhanced
- left atrial
- mitral valve
- patients undergoing
- end stage renal disease
- magnetic resonance
- congenital heart disease
- randomized controlled trial
- chronic kidney disease
- pulmonary hypertension
- cardiac resynchronization therapy
- early onset
- prognostic factors
- physical activity
- type diabetes
- computed tomography
- high intensity
- coronary artery disease
- pulmonary artery
- coronary artery
- emergency department
- oral anticoagulants
- electronic health record
- venous thromboembolism
- cardiovascular events
- percutaneous coronary intervention
- cardiovascular disease
- patient reported
- direct oral anticoagulants