The Journal of Thoracic and Cardiovascular Surgery
Adult: Aortic ValveThe fate of aortic valve after rheumatic mitral valve surgery
Graphical abstract
Section snippets
Study Subject and Outcome Measures
By using the institutional database of the Asan Medical Center, Seoul, Korea, we identified 1877 consecutive adult patients who underwent rheumatic MV surgery between January 1997 and December 2015. Among these, patients who underwent concomitant cardiac tumor resection or infective endocarditis and patients who had previously undergone mitral surgery were excluded (n = 146). We also excluded those who underwent concomitant AV surgery (AVR in 545, AV plasty in 20) and those who were missing
Study Subjects
The baseline variables of patients are summarized in Table 1. The mean age of the patients was 52.0 ± 12.9 years, and 807 (69.9%) were female. Atrial fibrillation (AF) was combined in the 856 patients (74.1%). At the time of MV surgery, 880 patients (76.2%), 256 patients (22.2%), and 19 patients (1.6%) had none, mild, and moderate degrees of AVD, respectively (Table 2). Among patients with moderate AVD, 6 patients have moderate degrees of pure AR and 5 patients have moderate degrees of pure AS.
Discussion
The present study demonstrated that severe dysfunction of native AV in patients undergoing rheumatic MV surgery was uncommon (Figure 5). Also, the development of severe AVD or the requirement of subsequent AVRs after MV surgery was associated with the AV peak pressure gradient, degree of AR, and time. To the best of our knowledge, our study on the fate of AV after rheumatic MV surgery has the largest cohort.
Most of the rheumatic heart disease lesions that require surgery involve the MV, and a
Conclusions
Progression of severe AVD and the need for AVR are uncommon in patients undergoing rheumatic MV surgery. However, such events were relatively common among those with mild or greater AVD at the time of MV surgery. Further comparative studies are warranted to determine whether concomitant AV surgery during rheumatic MV surgery may offer clinical benefits in patients with mild to moderate AVD.
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Institutional Review Board approval number: Institutional Review Board of Asan Medical Center (No. 2020-0875), May 7, 2021.