The Fate of Aortic Valve after Rheumatic Mitral Valve Surgery

Abstract Objective Deterioration of the native aortic valve (AV) function by a late progression of rheumatic disease is not infrequent in patients who underwent rheumatic mitral valve (MV) surgery, however, this phenomenon has not been clearly quantified. Methods Consecutive 1,155 patients (52.0±12.9 years; 807 females) who underwent rheumatic MV surgery without concomitant AV surgery from 1997 to 2015 were enrolled. The primary endpoint was the composite of progression to severe AV dysfunction (AVD) or a requirement of subsequent AV replacements during follow-up. To determine the risk factors of the primary outcome, we performed the generalized linear mixed model. Results The baseline severities of AV were none-to-trivial in 880 (76.2%), mild in 256 (22.2%), and moderate in 19 (1.6%). The latest 1062 echocardiographic assessments (91.9%; median, 81.2 postoperative months; IQR, 37.3-132.1 months) demonstrated overall 26 cases. (0.33%/patient-year) meeting the primary endpoint during follow-up. Cumulative incidence of the primary endpoint at 10-year was 0.4±0.3% and 7.4±2.5% depending on the presence of ≥mild AV dysfunction at baseline (P Conclusion Progression of severe AVD and the need for AVR are uncommon in patients undergoing rheumatic MV surgery. However, such events were relatively common among those with ≥ mild AV dysfunction at the time of MV surgery.