Effect of Concurrent Mitral Valve Surgery for Secondary Mitral Regurgitation Upon Mortality After Aortic Valve Replacement or Coronary Artery Bypass Surgery

Authors

Shyamal R Asher
Chin Siang Ong
Raymond J Malapero
Mahyar Heydarpour
Gregory W Malzberg
Jasmine T Shahram
Thy B Nguyen
Douglas C Shook
Stanton K Shernan
Prem Shekar
Tsuyoshi Kaneko
Rodolfo Citro
Jochen D Muehlschlegel
Simon C Body

Publication Date

1-1-2023

Journal

Frontiers in Cardiovascular Medicine

Abstract

OBJECTIVES: It is uncertain whether concurrent mitral valve repair or replacement for moderate or greater secondary mitral regurgitation at the time of coronary artery bypass graft or aortic valve replacement surgery improves long-term survival.

METHODS: Patients undergoing coronary artery bypass graft and/or aortic valve replacement surgery with moderate or greater secondary mitral regurgitation were reviewed. The effect of concurrent mitral valve repair or replacement upon long-term mortality was assessed while accounting for patient and operative characteristics and mitral regurgitation severity.

RESULTS: Of 1,515 patients, 938 underwent coronary artery bypass graft or aortic valve replacement surgery alone and 577 underwent concurrent mitral valve repair or replacement. Concurrent mitral valve repair or replacement did not alter the risk of postoperative mortality for patients with moderate mitral regurgitation (hazard ratio = 0.93; 0.75-1.17) or more-than-moderate mitral regurgitation (hazard ratio = 1.09; 0.74-1.60) in multivariable regression. Patients with more-than-moderate mitral regurgitation undergoing coronary artery bypass graft-only surgery had a survival advantage from concurrent mitral valve repair or replacement in the first two postoperative years (

CONCLUSIONS: These observations suggest that mitral valve repair or replacement for more-than-moderate mitral regurgitation at the time of coronary artery bypass grafting may be reasonable in a suitably selected coronary artery bypass graft population but not for aortic valve replacement, with or without coronary artery bypass grafting. Our findings are supportive of 2021 European guidelines that severe secondary mitral regurgitation "should" or be "reasonabl[y]" intervened upon at the time of coronary artery bypass grafting but do not support 2020 American guidelines for performing mitral valve repair or replacement concurrent with aortic valve replacement, with or without coronary artery bypass grafting.

Keywords

mitral valve surgery, aortic valve surgery, coronary artery bypass surgery, mortality, survival, outcomes, mitral regurgitation, guidelines