Attitude towards a moderate aortic valve dysfunction during rheumatic mitral valve surgery: a retrospective cohort study.

Background: There are insufficient data regarding how to deal with moderate aortic valve (AV) dysfunction during rheumatic mitral valve (MV) surgery. In this study, the clinical outcomes of patients who underwent rheumatic MV surgery with or without concurrent AV procedures were compared. Methods: A total of 343 patients who underwent rheumatic MV surgery with moderate AV dysfunction were enrolled between January 2015 and August 2022, and a median 40-month follow-up was conducted. The more-than-mild AV dysfunction during follow-up was the primary endpoint event, while all-cause mortality and cardiac reoperation both before discharge and during follow-up encompassed the secondary endpoint events. Results: Patients were allocated into two groups, including the no treatment (NT) (n=121) and aortic valvuloplasty (AVP) or aortic valve replacement (AVR) groups (n=222). Most of patients (110/121, 90.9%) in the NT group were combined with predominant aortic regurgitation. In the NT and AVP or AVR groups, 27.9% and 8.0% of patients reached the primary endpoint, and 5.0% and 7.3% of patients experienced the secondary endpoint events, respectively. This study confirmed a significantly higher proportion of patients in the NT group who reached the primary endpoint (relative risk, 2.98; 95% confidence interval: 1.61-5.62; P<0.001), after inverse probability treatment weighting. Conclusions: Concomitant AV surgery significantly improved AV condition during follow-up for patients with moderate AV dysfunction during rheumatic valve surgery. However, it was safe and reasonable to delay surgical treatment of the AV and regular follow-ups for patients with predominant moderate aortic regurgitation.