Is Concomitant Surgery for Moderate Functional Mitral Regurgitation Indicated during Aortic Valve Replacement for Aortic Stenosis? A Systematic Review and Evidence-Based Recommendations

摘要

Aortic valve stenosis (AS) is the most commonly acquired valve pathology; subsequently, aortic valve replacement (AVR) is the most frequently performed valve operation.1 Echocardiography-supported literature indicates that mitral regurgitation (MR) is commonly associated with patients undergoing AVR for AS. This may be a result of structural mitral valve (MV) disease, although predominantly it is of a func-tional mechanism as a consequence of increased af-terload and left ventricular remodelingIn patients undergoing AVR for severe AS with functional MR, the clinical decision to surgically intervene on the MV concomitantly is based on the degree of MR. While reported mortality for isolated AVR is 3% to 5%, mortality with concomitant MV repair or replacement ranges between 5% and 15%.The evidence is clear to not surgically intervene with mild functional MR and to perform a repair or replacement when severe MR exists. There is no consensus regarding moderate functional MR.