Objective To evaluate clinical outcomes of mild-to-moderate or moderate functional mitral regurgitation（FMR）after aortic valve replacement （AVR） in patients with severe aortic stenosis （AS），and analyze prognostic factors of these patients with mild-to-moderate or moderate FMR （2＋to 3＋）. Methods From September 2008 to December 2011，a total of 156 patients with severe AS （peak aortic gradient （PAG）≥50 mm Hg） as well as FMR （2＋to 3＋） underwent surgical treatment in Zhongshan Hospital. There were 95 male and 61 female patients with their average age of 59.2±10.5 years. Detailed perioperative clinical data were collected，and postoperative patients were followed up. The ratio of FMRpreoperative/FMR postoperative was calculated. Patient age，gender，body weight，history of hypertension，ventricular arrhythmia，atrial fibrillation （AF），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD），left atrial diameter （LAD），pulmonary artery hypertension （PAH），PAG were assessed by logistic multivariate regression analysis. Results Six patients died postoperatively，including 4 patients with low cardiac output syndrome and 2 patients with refractory ventricular arrhythmia. Perioperative mortality was 3.8%. The average follow-up time was 20.3±8.5 months and follow-up rate was 85.3% （133/156）. Eight patients died during follow-up，including 3 patients with heart failure，2 patients with ventricular arrhythmia，and 3 patients with anticoagulation-related cerebrovascular accident. Multivariate regression analysis showed that FMR preoperative/FMR postoperative ratio was not correlated with age≥55 years，male gender，body weight≥80 kg，LVEDD≥55 mm，LVEF≤50%，history of hypertension or ventricular arrhythmia. However，LAD≥50 mm，PAH≥50 mm Hg，PAG≤75 mm Hg and preoperative AF were negatively correlated with postoperative FMR improvement. Conclusions Risk factors including LAD≥50 mm，PAH≥50 mm Hg，PAG≤75 mm Hg and preoperative AF are negatively correlated with postoperative improvement of FMR （2＋to 3＋）. Patients with severe AS and above risk factors should receive concomitant surgical treatment for their FMR during AVR，since preoperative FMR（2＋to 3＋）usually does not improve or even aggravate after AVR.
ObjectiveTo explore surgical techniques and follow-up results of concomitant transaortic repair for moderate functional mitral regurgitation (MR)during surgical treatment for aortic root or aortic valve disease. MethodsClinical data of 25 patients who underwent concomitant transaortic repair for moderate functional MR during surgical treat-ment for aortic root or aortic valve disease between January 2006 and June 2012 in Xinhua Hospital were retrospectively analyzed. There were 18 male and 7 female patients with their age of 42-75 (57.9±9.6)years. All these patients had aortic root or aortic valve disease as well as concomitant moderate functional MR (type I Carpentier's classification). Aortic valve replacement or aortic root replacement and concomitant transaortic mitral valvuloplasty (MVP, commissure repair)were performed under general anesthesia, hypothermia and cardiopulmonary bypass. Patients were followed up at the outpatient department as well as with phone calls to evaluate the structures and function of the mitral valve and the heart. ResultsIntraoperative transesophageal echocardiography showed satisfactory MVP results as trivial residual MR in 2 patients and no MR or mitral stenosis in the other 23 patients. There was no in-hospital death in this group. Postoperative echocardiography showed that left atrial diameter and left ventricular end-diastolic dimension were significantly reduced than preoperative values (t=4.086, P=0.000;t=4.442, P=0.000), and left ventricular ejection fraction (LVEF)was significantly lower than preoperative LVEF (t=3.671, P=0.001). Postoperative mitral annulus diameter (MAD)was smaller than preoperative MAD (32.4±3.6 mm vs. 35.6±6.4 mm). Postoperative mitral valve pressure gradient (MVPG)(1.4±0.7 mm Hg vs. 1.5±0.7 mm Hg)and peak MVPG (3.7±2.2 mm Hg vs. 3.3±1.5 mm Hg)were no statistical difference than preoperative values. Twenty-three patients (92%)were followed up after discharge for 7-92 (50.4±25.3)months, and the other 2 patients were lost in follow-up. Three patients had mild MR during follow-up. Latest echocardiography examination showed MAD was 33.9±4.6 mm, MVPG was 1.3±0.6 mm Hg, and peak MVPG was 3.6±2.3 mm Hg. ConclusionConcomitant transaortic MVP during surgical treatment for aortic root or aortic valve disease is a safe, convenient and effective procedure for the treatment of moderate functional MR.
Atrial functional mitral regurgitation has been referred to patients with atrial fibrillation related functional mitral regurgitation without left ventricular dysfunction and it has nowadays received remarked attention in structural heart disease field. Significant dilation of mitral annulus and left atrium, insufficient leaflet remodeling, iatrogenic leaflet tethering, reduced annular contractility and increased valve stress by flattened saddle shape of the annulus might be important triggers of atrial functional mitral regurgitation. Recently, several studies indicated that transcatheter edge-to-edge mitral valve repair could be an effective strategy for atrial functional mitral regurgitation. In this review, the definition, mechanism together with efficacy and safety of transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation are discussed.