Progression of Coexistent Aortic Valve Disease and Its Clinical Outcome in Patients Who Underwent Mitral Valve Surgery: A Single-Centre Observational Cohort Study.

backgroundCoexistent mild aortic valve disease is frequently observed in patients undergoing mitral valve surgery, yet the clinical significance and progression of these lesions remain uncertain. This study aimed to evaluate the progression and clinical outcomes of mild aortic valve disease following mitral valve surgery.

methodsThis single-centre observational study included 80 patients who underwent primary mitral valve surgery with documented mild aortic valve disease. Patients were evaluated through a hybrid design, consisting of a retrospective cohort (n=43) from 2010 to 2017 and a prospective cohort (n=37) from 2016 to 2019, using echocardiographic and clinical assessments.

resultsAt baseline, out of the 80 patients, 82.5% (n=66) presented with aortic regurgitation (AR) lesions, which comprised isolated mild AR (n=53; 66.2%), trivial AR (n=4; 5%), moderate AR (n=4; 5%), and mixed mild AR with mild aortic stenosis (AS) (n=5; 6.2%). The remaining 17.5% (n=14) presented with isolated mild AS. Follow-up clinical and echocardiographic assessment was completed in 74 patients, while six patients were lost to follow-up. During follow-up (mean duration: 3.54±1.48 years), most assessed patients remained clinically and echocardiographically stable. Among patients with isolated mild AR at baseline, eight patients progressed to moderate AR, while the remaining patients did not demonstrate clinically meaningful progression. Pressure half-time decreased from 643.53±103.90 ms preoperatively to 592.30±120.55 ms postoperatively (t=5.122; p<0.001), and vena contracta increased from 0.26±0.05 cm to 0.31±0.10 cm (t=4.472; p<0.001), without clinically significant deterioration. In patients with aortic stenosis, the aortic valve area decreased from 1.66±0.04 cm² to 1.59±0.02 cm² (t=2.047; p=0.044), and the mean gradient increased from 16±1.73 mmHg to 19±1.00 mmHg (t=2.145; p=0.035). Kaplan-Meier analysis demonstrated an event-free survival rate of 94.6% at the final follow-up. Multivariate analysis identified preoperative aortic valve lesion as the only significant predictor of disease progression (OR: 0.038; 95% CI: 0.002-0.948; p=0.046).

conclusionsMild aortic valve disease in patients undergoing mitral valve surgery generally remains stable and does not demonstrate significant clinical progression. Routine echocardiographic surveillance remains important to identify the minority of patients who may develop progressive valve dysfunction.