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Meta-Analysis
. 2020 Oct 8;17(19):7335.
doi: 10.3390/ijerph17197335.

The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement -Meta-Analysis

Ilija Bilbija  1   2 , Milos Matkovic  1   2 , Marko Cubrilo  1 , Nemanja Aleksic  1   2 , Jelena Milin Lazovic  3 , Jelena Cumic  4 , Vladimir Tutus  4 , Marko Jovanovic  5 , Svetozar Putnik  1   2
Affiliations
Meta-Analysis

The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement -Meta-Analysis

Ilija Bilbija et al. Int J Environ Res Public Health. .

Abstract

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36-2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35-0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

Keywords: aortic stenosis; aortic valve replacement; combined aortic mitral surgery; mitral regurgitation.

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Conflict of interest statement

The authors declare that they have no competing financial and/or non-financial interests.

Figures

Figure 1
Figure 1
PRISMA flow chart of literature search.
Figure 2
Figure 2
Risk of bias–estimation across studies.
Figure 3
Figure 3
The forest plot of risk ratio of MR after AVR. The outcome: severe MR.
Figure 4
Figure 4
The forest plot of risk ratio of MR after AVR. The outcome: moderate/severe MR.
Figure 5
Figure 5
Funnel plot analysis for publication bias.
Figure 6
Figure 6
The change in LVEDD after AVR.
Figure 7
Figure 7
Mitral annulus diameter change after AVR.
Figure 8
Figure 8
Comparative 30-day mortality: nil/mild vs. moderate/severe MR groups.
Figure 9
Figure 9
5-year survival comparison: nil/mild vs. moderate/severe MR groups.
See this image and copyright information in PMC

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