Mitral regurgitation after previous aortic valve surgery for bicuspid aortic valve insufficiency
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Mitral regurgitation after previous aortic valve surgery for bicuspid aortic valve insufficiency. / Girdauskas, Evaldas; Disha, Kushtrim; Espinoza, Andres; Misfeld, Martin; Reichenspurner, Hermann; Borger, Michael A; Kuntze, Thomas.
In: J CARDIOVASC SURG, Vol. 58, No. 3, 06.2017, p. 473-480.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Mitral regurgitation after previous aortic valve surgery for bicuspid aortic valve insufficiency
AU - Girdauskas, Evaldas
AU - Disha, Kushtrim
AU - Espinoza, Andres
AU - Misfeld, Martin
AU - Reichenspurner, Hermann
AU - Borger, Michael A
AU - Kuntze, Thomas
PY - 2017/6
Y1 - 2017/6
N2 - BACKGROUND: Regurgitant bicuspid aortic valves (BAV) are reported to be associated with myxomatous degeneration of the anterior mitral leaflet. We examined the risk of late new-onset mitral regurgitation (MR) in patients who underwent aortic valve/aortic root surgery for BAV regurgitation and concomitant root dilatation.METHODS: A total of 97 consecutive patients (47±11 years, 94% men) were identified from our institutional BAV database (N.=640) based on the following criteria: 1) BAV regurgitation; 2) aortic root diameter >40 mm; 3) no relevant mitral valve disease (i.e., MR<2+) and no simultaneous mitral intervention at the time of BAV surgery. All patients underwent isolated aortic valve replacement (AVR subgroup, N.=59) or aortic root replacement with a composite graft (i.e., for root aneurysm >50 mm) (ARR subgroup, N.=38) from 1995 through 2008. Echocardiographic follow-up (1009 patient-years) was obtained for all 96 (100%) hospital survivors. The primary endpoint was freedom from new-onset MR>2+ and redo mitral valve surgery.RESULTS: Nine patients (9.4%) showed new-onset MR>2+ after mean echocardiographic follow-up of 10.4±4.0 years postoperatively. Myxomatous degeneration and prolapse of the anterior mitral leaflet was found in all 9 patients, and the posterior leaflet was involved in 3 of them. Two patients (2%) in AVR subgroup underwent re-do mitral surgery. No MR>2+ occurred in ARR subgroup. Freedom from MR>2+ or mitral surgery at 15 years was significantly lower in AVR subgroup vs. ARR subgroup (i.e., 38% vs. 100%, P=0.01).CONCLUSIONS: The risk of new-onset MR is significantly increased in patients with BAV regurgitation and aortic root dilatation who undergo isolated AVR rather than root replacement. The mechanism by which aortic root replacement may prevent the occurrence of late MR in BAV root phenotype patients is to be determined.
AB - BACKGROUND: Regurgitant bicuspid aortic valves (BAV) are reported to be associated with myxomatous degeneration of the anterior mitral leaflet. We examined the risk of late new-onset mitral regurgitation (MR) in patients who underwent aortic valve/aortic root surgery for BAV regurgitation and concomitant root dilatation.METHODS: A total of 97 consecutive patients (47±11 years, 94% men) were identified from our institutional BAV database (N.=640) based on the following criteria: 1) BAV regurgitation; 2) aortic root diameter >40 mm; 3) no relevant mitral valve disease (i.e., MR<2+) and no simultaneous mitral intervention at the time of BAV surgery. All patients underwent isolated aortic valve replacement (AVR subgroup, N.=59) or aortic root replacement with a composite graft (i.e., for root aneurysm >50 mm) (ARR subgroup, N.=38) from 1995 through 2008. Echocardiographic follow-up (1009 patient-years) was obtained for all 96 (100%) hospital survivors. The primary endpoint was freedom from new-onset MR>2+ and redo mitral valve surgery.RESULTS: Nine patients (9.4%) showed new-onset MR>2+ after mean echocardiographic follow-up of 10.4±4.0 years postoperatively. Myxomatous degeneration and prolapse of the anterior mitral leaflet was found in all 9 patients, and the posterior leaflet was involved in 3 of them. Two patients (2%) in AVR subgroup underwent re-do mitral surgery. No MR>2+ occurred in ARR subgroup. Freedom from MR>2+ or mitral surgery at 15 years was significantly lower in AVR subgroup vs. ARR subgroup (i.e., 38% vs. 100%, P=0.01).CONCLUSIONS: The risk of new-onset MR is significantly increased in patients with BAV regurgitation and aortic root dilatation who undergo isolated AVR rather than root replacement. The mechanism by which aortic root replacement may prevent the occurrence of late MR in BAV root phenotype patients is to be determined.
KW - Adolescent
KW - Adult
KW - Aged
KW - Aortic Valve/abnormalities
KW - Aortic Valve Insufficiency/diagnosis
KW - Bicuspid Aortic Valve Disease
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Databases, Factual
KW - Disease-Free Survival
KW - Echocardiography, Doppler, Color
KW - Female
KW - Germany
KW - Heart Valve Diseases/complications
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Hospital Mortality
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Mitral Valve Insufficiency/diagnostic imaging
KW - Mitral Valve Prolapse/diagnostic imaging
KW - Reoperation
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Young Adult
U2 - 10.23736/S0021-9509.16.09311-3
DO - 10.23736/S0021-9509.16.09311-3
M3 - SCORING: Journal article
C2 - 27012929
VL - 58
SP - 473
EP - 480
JO - J CARDIOVASC SURG
JF - J CARDIOVASC SURG
SN - 0021-9509
IS - 3
ER -
