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Bilbija I, Matkovic M, Cubrilo M, Aleksic N, Milin Lazovic J, Cumic J, Tutus V, Jovanovic M, Putnik S. The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement -Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197335. [PMID: 33049955 PMCID: PMC7579159 DOI: 10.3390/ijerph17197335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/16/2020] [Accepted: 09/30/2020] [Indexed: 01/30/2023]
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.
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Affiliation(s)
- Ilija Bilbija
- Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.M.); (M.C.); (N.A.); (S.P.)
- Department of Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence:
| | - Milos Matkovic
- Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.M.); (M.C.); (N.A.); (S.P.)
- Department of Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Cubrilo
- Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.M.); (M.C.); (N.A.); (S.P.)
| | - Nemanja Aleksic
- Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.M.); (M.C.); (N.A.); (S.P.)
- Department of Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Milin Lazovic
- Department for Biostatistics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Jelena Cumic
- Department for Anesthesiology and Intensive Care, Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.C.); (V.T.)
| | - Vladimir Tutus
- Department for Anesthesiology and Intensive Care, Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.C.); (V.T.)
| | - Marko Jovanovic
- Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia;
| | - Svetozar Putnik
- Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.M.); (M.C.); (N.A.); (S.P.)
- Department of Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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van Mieghem NM, Head SJ, van der Boon R, Piazza N, de Jaegere PP, Carrel T, Kappetein AP, Lange R, Walther T, Windecker S, van Es GA, Serruys PW. The SURTAVI model: proposal for a pragmatic risk stratification for patients with severe aortic stenosis. EUROINTERVENTION 2012; 8:258-66. [DOI: 10.4244/eijv8i2a40] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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