Published online May 26, 2023. doi: 10.4330/wjc.v15.i5.253
Peer-review started: December 20, 2022
First decision: February 20, 2023
Revised: March 20, 2023
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: May 26, 2023
Processing time: 150 Days and 0.1 Hours
Severe aortic stenosis (AR) and concomitant mitral regurgitation (MR) are common. But the impact of MR in those with severe AS on outcomes and management are unknown.
To study the impact of concomitant MR on outcomes in severe AS.
Does MR affect prognosis and decision making in severe AS patients.
Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003, 287 underwent AVR forming the study cohort. They were followed up to death or till the end of 2019. Chart reviews were performed for clinical, echocardiographic, and therapeutic data. MR was graded on a 1-4 scale. Mortality data was obtained from chart review and the Social Security Death Index. Survival was analyzed as a function of degree of MR.
Presence of MR was associated with higher mortality in a graded fashion. MR was significantly associated with lower left ventricular (LV) ejection fraction and larger LV size. Impact of MR on mortality was partially mediated through lower LV ejection fraction and larger LV size. By Cox regression, MR, lower ejection fraction (EF) and larger LV end-systolic dimension were independent predictors of higher mortality.
Presence of greater than 2+ MR in patients with severe AS is independently associated with reduced survival in surgically managed patients, an effect incremental to reduced EF and larger LV size. We suggest that aortic valve intervention should be considered in severe AS patients when > 2+ MR occurs irrespective of EF or symptoms.
More studies are needed to study the mechanisms of MR and its prevention in severe AS patients.