Department for Cardiac Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia.
Department of Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Int J Environ Res Public Health. 2020 Oct 8;17(19):7335. doi: 10.3390/ijerph17197335.
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; < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35-0.57; < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher ( < 0.0001) and long-term survival significantly worse ( < 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.
主动脉瓣置换术治疗主动脉瓣狭窄是最常见的心脏瓣膜手术之一。这些患者常伴有二尖瓣反流。为了揭示单纯主动脉瓣置换术是否会改善中度二尖瓣反流，我们进行了系统评价和荟萃分析。我们确定了 27 项研究，共纳入 4452 例因主动脉瓣狭窄而行主动脉瓣置换术且伴有二尖瓣反流的患者。主要终点是主动脉瓣置换术对并存的二尖瓣反流的影响。次要终点是分析左心室逆重构和长期生存率。我们的结果显示，二尖瓣反流术后有显著改善（RR，1.65；95%CI 1.36-2.00；<0.00001），平均减少 0.46（WMD；95%CI 0.35-0.57；<0.00001）。在老年人群中效果更为明显。术前存在中度/重度二尖瓣反流的患者围手术期死亡率更高（<0.0001），长期生存率显著更差（<0.00001）。我们得出结论，单纯主动脉瓣置换术后，中度二尖瓣反流有一定改善的机会，但只是轻微改善。应在主动脉瓣置换术时解决次要的中度二尖瓣反流。对于老年和高危患者，应采取更为保守的方法。
