The following is a summary of “Fate of aortic valve after rheumatic mitral valve surgery,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Kim et al.
In patients who have undergone rheumatic mitral valve surgery, it is not uncommon for the native aortic valve function to deteriorate due to a late progression of rheumatic disease.
Patient enrollment occurred between 1997 and 2015 and included 1,155 consecutive patients (age 52.0 ± 12.9 years; 807 female) who had rheumatic mitral valve surgery without concurrent aortic valve surgery. Follow-up replacement or worsening aortic valve function was considered the primary endpoint. The generalized linear mixed model was utilized to identify potential predictors of the primary outcome.
Around 880 patients (76.2%) had no or mild aortic valve disease at baseline, 256 patients (22.2%) had mild aortic valve disease, and 19 patients (1.6%) had moderate aortic valve disease. Newest echocardiographic evaluations of 1,062 patients (91.9%; median, 81.2 postoperative months; interquartile range, 37.3-132.1 months) revealed 26 patients (0.33%/patient-year) who met the primary endpoint. At ten years, the cumulative incidence of the primary endpoint was 0.4% ± 0.3% in patients with mild aortic valve dysfunction and 7.4% ± 2.5% in patients with moderate or severe aortic valve dysfunction at baseline (P<.01).
The primary endpoint was significantly associated with aortic regurgitation degree (mild over none: odds ratio, 3.26; 95% CI, 1.15-9.23), aortic valve peak pressure gradient (odds ratio, 1.14; 95% CI, 1.10-1.20), and time (odds ratio, 1.30; 95% CI, 1.19-1.41). Patients with rheumatic mitral valve disease rarely progress to severe aortic valve dysfunction and require aortic valve replacement after mitral valve repair. However, those with moderate or severe aortic valve dysfunction before mitral valve surgery were more likely to experience such complications.
Source: sciencedirect.com/science/article/abs/pii/S0022522321005298