Long-Term Outcome of Clinically Insignificant Aortic Valve Disease in Patients Undergoing Mitral Valve Surgery for Rheumatic Heart Disease

ABSTRACT

BACKGROUND AND OBJECT A considerable proportion of patients who require mitral valve (MV) replacement present with a coexisting pathology of the aortic valve (AV). However, combined AV and MV replacement is associated with higher operative risk and poorer long-term survival than MV replacement (MVR) only. Little is known about the natural history of AV disease in patients undergoing MV surgery. The purpose of this study was to analyze long-term clinical outcome and the need for subsequent AV replacement (AVR) in patients with mild to moderate AV disease at the time of MV surgery. MATERIALS AND METHODS: One hundred forty-one patients (97 female, mean age 43 years) with mild to moderate AV disease and severe rheumatic MV disease were treated with MV surgery. The patients were followed for an average period of 8+/-3 years (range 1-16) after MV surgery. Primary outcomes (death and subsequent AVR) were evaluated. METHODS: At the time of MV surgery, 104 patients (73.8%) had mild aortic regurgitation (AR), 37 patients (26.2%) moderate AR, 5 patients (3.5%) mild aortic stenosis (AS) and 2 patients (1.4%) moderate AS. At the end of follow-up period, only one patient had severe AR. Eight patients (5.7%) died during the follow-up, and four patients (2.8%) treated with AVR after a mean period of 9 years. Survival analysis with Kaplan-Meier method revealed 10-year survival rates of 95.5% and 10-year event free survival rates of 93.6%. CONCLUSION: In most patients with mild to moderate rheumatic AV disease at the time of MV surgery, subsequent AVR is rarely needed after a long follow-up period. These data may support the decision not to recommend prophylactic AVR at the time of MV surgery in these patients.