OBJECTIVE
To evaluate the results of surgical treatment in patients with functional mitral regurgitation (FMR) and aortic valve disease.
MATERIAL AND METHODS
We retrospectively analyzed (median follow-up 61 months) postoperative outcomes in 108 patients with FMR >2 and aortic valve disease. Depending on mitral regurgitation (MR) mechanism, all patients were divided into type I (n=31) and type IIIb (n=77). Each type of mitral dysfunction was analyzed depending on mitral valve (MV) surgery: isolated aortic valve replacement (AVR), suture annuloplasty, remodeling annuloplasty (RA), multicomponent reconstructions with interventions on subvalvular structures. We examined patients before surgery, in early and late postoperative period. Hemodynamic parameters, complications, mortality, freedom from MR >2, effective left ventricular reverse remodeling, quality of life and mortality were studied.
RESULTS
In early postoperative period, 1 patient with MR type I died after isolated AVR. There were 2 redo surgeries after isolated AVR and suture annuloplasty. There were no differences in morbidity. Three patients with MR type IIIb died in early postoperative period (2 after isolated AVR and 1 after multicomponent reconstruction). There were no redo surgeries and differences in morbidity (p=0.24). In long-term postoperative period, there were no deaths or redo surgeries among patients with MR type I. Unsatisfactory quality of life was noted by 56% of patients without MV repair and all patients after suture repair. Better quality of life was observed after RA. There was no MR >2 after RA. Effective LV reverse remodeling was achieved in 100% of cases after RA, 74% without intervention and was absent after suture repair. Six patients with MR type IIIb died in long-term period. There were no significant between-group differences (p=0.50). There were 5 redo surgeries (the largest number after isolated AVR due to progression of MR). Unsatisfactory quality of life was detected in 28 patients (6 (60%) after suture repair and 13 (59%) after isolated AVR). MR >2 was absent in all patients after RA with reduction of interpapillary distance and resection of secondary chordae, 14% (n=3) after RA, 50% without intervention and 40% after isolated suture repair. Effective LV reverse remodeling was achieved in 89% of cases after RA with reduction of interpapillary distance, 100% after resection of secondary chordae, 95% after RA, 80% after suture repair and 68% without intervention.
CONCLUSION
RA is advisable in patients with type I FMR ≥2 and aortic valve disease, mitral annulus ≥38 mm and LV EDV ≥200 ml for more predictable long-term results. In type IIIb mitral dysfunction, the indication for surgical intervention is MR ≥2, mitral annulus ≥40 mm, LV EDV ≥250 ml. Multicomponent MV reconstructions with interventions on subvalvular structures or MV replacement is advisable for IPD >35 mm. In case of IPD <35 mm and tethering <8 mm, RA is effective. IPD <35 mm and coaptation depth >8 mm require multicomponent reconstructions with interventions on subvalvular structures or MV replacement.
