Abstract 13147: Outcome of Combined Aortic Stenosis and Mitral Regurgitation
Background: Although aortic stenosis (AS) and mitral regurgitation (MR) frequently coexist, data on this disease are scarce.
Methods: 89 consecutive patients (65 female, age 78 ± 9 yrs) with severe AS (baseline peak aortic velocity 4.7 ± 0.8 m/s) in combination with at least moderate MR (72 functional; 17 degenerative) were included and followed. Outcome was assessed and overall survival was determined.
Results: 76 patients were symptomatic at presentation, of which 60 had severe symptoms (NYHA class ≥ 2.5) and 25 had a recent episode of cardiac decompensation. The 13 asymptomatic patients had an event-free survival of 40±15% at 2 years. Overall, 84 patients had an indication for surgery, which was not performed in 35 pts for the following reasons: patient refusal (n=16), high surgical risk (n=12), surgery aborted due to porcelain aorta (n=1), death related to heart failure before surgery (n=6). 49 patients underwent surgery: Isolated aortic valve intervention in 29 patients (22 valve replacement, 7 TAVI), concomitant mitral valve surgery was performed in 9 of 10 patients with degenerative and in 11 of 39 patients with functional MR. Survival was significantly better for patients undergoing surgery with survival rates of 86±5%, 86±5% and 75±9% at 1, 2 and 5 years, respectively as compared to 68±9%, 35±11% and 23±10% for patients managed conservatively (p < 0.001) (Figure 1). 6 of 15 patients with moderate-to-severe TR died within 3 months postoperatively as compared to 1 of 35 with no or mild TR (p = 0.01).
Conclusion: Severe AS with coexisting MR is associated with an unfavorable outcome and is found predominantly in elderly symptomatic patients. In these patients, valve intervention, which is associated with a survival-benefit, is frequently not performed. High-risk patients with severe AS and significant functional MR may benefit from isolated aortic intervention. However, coexisting significant TR is associated with excessive early postoperative mortality.
- © 2013 by American Heart Association, Inc.