The fate of aortic valve after rheumatic mitral valve surgery |
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| Affiliation: | 1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea;2. Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Gyeonggi-do, Republic of Korea;1. Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md;2. Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md;3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md;4. Maryland Cardiac Surgery Quality Initiative, Inc, Baltimore, Md;5. Division of Cardiothoracic Surgery, Suburban Hospital, Bethesda, Md;6. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md;7. Adventist Healthcare White Oak Medical Center, Silver Spring, Md;1. Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, South Korea;2. Department of Thoracic and Cardiovascular Surgery, Research Nurse, Sejong General Hospital, Bucheon, Gyeonggi-do, South Korea;3. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi-do, South Korea;4. Department of Cardiology, Sejong General Hospital, Bucheon, Gyeonggi-do, South Korea;5. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;6. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;1. Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, South Korea;2. Department of Nursing, Asan Medical Center, Seoul, South Korea;3. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;1. Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea;2. Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea;3. Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;4. Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;5. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea |
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| Abstract: | ObjectiveDeterioration of the native aortic valve function by a late progression of rheumatic disease is not infrequent in patients who underwent rheumatic mitral valve surgery; however, this phenomenon has not been clearly quantified.MethodsA total of 1155 consecutive patients (age 52.0 ± 12.9 years; 807 female) who underwent rheumatic mitral valve surgery without concomitant aortic valve surgery from 1997 to 2015 were enrolled. The primary end point was the composite of progression to severe aortic valve dysfunction or a requirement of subsequent aortic valve replacements during follow-up. To determine the risk factors of the primary outcome, we performed the generalized linear mixed model.ResultsThe baseline severities of aortic valve were none to trivial in 880 patients (76.2%), mild in 256 patients (22.2%), and moderate in 19 patients (1.6%). The latest 1062 echocardiographic assessments (91.9%; median, 81.2 postoperative months; interquartile range, 37.3-132.1 months) demonstrated 26 cases (0.33%/patient-year) meeting the primary end point during follow-up. Cumulative incidence of the primary end point at 10 years was 0.4% ± 0.3% and 7.4% ± 2.5% depending on the presence of mild or greater aortic valve dysfunction at baseline (P < .01). In multivariable analyses, aortic valve peak pressure gradient (odds ratio, 1.14; 95% confidence interval, 1.10-1.20), aortic regurgitation degree (mild over none: odds ratio, 3.26; 95% confidence interval, 1.15-9.23), and time (odds ratio, 1.30; 95% confidence interval 1.19-1.41) were significantly associated with the occurrence of the primary end point.ConclusionsProgression of severe aortic valve dysfunction and the need for aortic valve replacement are uncommon in patients undergoing rheumatic mitral valve surgery. However, such events were relatively common among those with mild or greater aortic valve dysfunction at the time of mitral valve surgery. |
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