Surgical Methods And Prognosis Analysis Of Patients With Aortic Regurgitation Complicated With Moderate Functional Mitral Regurgitation

Objective To investigate the perioperative prognosis and near-medium term efficacy of different surgical management methods in patients with severe aortic regurgitation(AR)with moderate functional mitral regurgitation(FMR).Methods Clinical data of Aortic Valve replacement(AVR)patients with aortic regurgitation complicated with moderate FMR in Nanjing First Hospital from January 2015 to September 2021 were retrospectively analyzed.According to the different surgical methods,the included patients were divided into mitral valvoplasty group(AVR+MVP group,n=59)and untreated mitral valve group(AVR group,n=124).The clinical characteristics of preoperative,operative and postoperative data of the two groups were compared,and the perioperative prognosis and improvement degree of mitral valve regurgitation of the two groups were analyzed.Meanwhile,the patients were followed up by telephone and outpatient review to compare the effects of the two groups in the near and middle period after surgery.Results A total of 59 of 184 patients underwent mitral valvoplasty(MVP)at the same time(32.2%).Compared with the AVR group,patients in the AVR+MVP group had higher NYHA classification,lower LVEF,poorer renal function,more patients complicated with atrial fibrillation,tricuspid insufficiency,pulmonary hypertension,and worse preoperative MR and large left atrial diameter(P<0.05).There was no significant difference in postoperative complications or perioperative survival between the two groups(P>0.05),although the combined operation resulted in a longer aorta occlusion time and cardiopulmonary bypass time and longer postoperative ICU stay.In the early postoperative echocardiography data(before discharged),it was found that the degree of FMR imporved in both groups,but patients in the AVR+MVP group had a more significant improvement.In the early and middle term follow-up,FMR was improved in most patients(88.2% to 81.7%,P>0.05),there were no significant differences in survival,incidence of major adverse cardiovascular and cerebrovascular events between the two groups.Conclusion Whether or not mitral valvoplasty was performed,FMR would be improved in some degree after AVR,and mitral valvoplasty improved FMR significantly in the early postoperative period.There were no significant differences in perioperative survival,mortality and major adverse cardiovascular and cerebrovascular events between the two groups.At the same time,patients with worse preoperative cardiac function,left atrial enlargement,decreased left ventricular systolic function,combined with atrial fibrillation,tricuspid insufficiency,and pulmonary hypertension may be more inclined to treat the mitral valve at the same time with AVR.