The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

Ilija Bilbija, Milos Matkovic, Marko Cubrilo, Nemanja Aleksic, Jelena Milin Lazovic, Jelena Cumic, Vladimir Tutus, Marko Jovanovic and Svetozar Putnik
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Ilija Bilbija: Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
Milos Matkovic: Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
Marko Cubrilo: Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
Nemanja Aleksic: Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
Jelena Milin Lazovic: Department for Biostatistics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
Jelena Cumic: Department for Anesthesiology and Intensive Care, Clinical Center of Serbia, 11000 Belgrade, Serbia
Vladimir Tutus: Department for Anesthesiology and Intensive Care, Clinical Center of Serbia, 11000 Belgrade, Serbia
Marko Jovanovic: Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia
Svetozar Putnik: Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia

IJERPH, 2020, vol. 17, issue 19, 1-14

Abstract: Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher ( p < 0.0001) and long-term survival significantly worse ( p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

Keywords: mitral regurgitation; aortic valve replacement; aortic stenosis; combined aortic mitral surgery (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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