Kim, Do Jung; Joo, Hyun-Chel; Lee, Seung-Hyun; Chang, Byung-Chul; Lee, Sak
Interactive cardiovascular and thoracic surgery
2018Jun ; 265 ( 4 ) :.
PMID : 29873732
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Kim, Do Jung - Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Joo, Hyun-Chel - Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Lee, Seung-Hyun - Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Chang, Byung-Chul - Department of Thoracic and Cardiovascular Surgery, Cha Bundang Medical Center, Cha University, Seoul, Korea.
Lee, Sak - Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
ABSTRACT
OBJECTIVES: The aim of this study was to examine long-term clinical outcomes and to assess the eventual need for aortic valve replacement (AVR) in patients with mild aortic valve disease (AVD) at the time of mitral valve replacement.
METHODS: Between 1990 and 2015, 1231 patients undergoing mitral valve replacement were reviewed, stratifying subjects as those with AVD (n?=?363) or without AVD (NA; n?=?868). Primary end points were progressive AVD (grade???II) and subsequent AVR. Overall mortality and valve-related complications served as secondary end points. Propensity score matching was used for risk adjustment (n?=?320 in each group).
RESULTS: No differences in postoperative complications or clinical outcomes were observed between groups. The 20-year overall survival was similar (before matching: NA 86.1% vs AVD 80.8%, P?=?0.128; after matching: 83.5% vs 81.1%, P?=?0.425). Of the entire cohort, progressive AVD was observed in 162 patients, and significant AVD (grade???III) was observed in only 60 patients. Subsequent AVR was required in 37 patients due to mitral valve (MV) dysfunction or severe aortic stenosis. The 20-year freedom from significant AVD and subsequent AVR was significantly higher in the NA group than in the AVD group before and after matching (before: NA, 96.5% vs 73.7%, P?
CONCLUSIONS: Although progressive AVD did not significantly impact long-term survival during the follow-up period, those patients qualifying initially as mild AVD may eventually progress to significant AVD after the first 5 postoperative years. Therefore, aggressive echocardiography should be performed at 5-year lapse after mitral valve replacement to determine the appropriate timing of AVR.
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