Results of aortic valve replacement in aortic stenosis and moderate functional mitral regurgitation

Background: Referral and admission echocardiography (ECHO) in patients scheduled for aortic valve replacement (AVR) with aortic stenosis (AS) may differ in the assessment of moderate functional mitral regurgitation (FMR).Aims: Our study aimed to determine truly moderate FMR and evaluate its impact on survival.Methods: We conducted an observational study of patients referred for AVR with AS and no, mild, or moderate FMR between 2014 and 2019. Patients were assigned into three groups: (1) no/mild (N-FMR); (2) moderate-FMR on one ECHO (either at referral or on admission) termed incidental (I-FMR); (3) moderate FMR in two studies (both at referral and on admission) termed permanent (PM-FMR).Results: The referral and admission assessment were performed median 35 days apart. Of the 679 elective patients who underwent elective isolated AVR, 516 patients had N-FMR, 102 patients had I-FMR, and 61 patients had PM-FMR. Median follow-up was 46 months (22.5-58.5); max 73.3. Thir-ty-day mortality was 2.5% vs. 1% vs. 8.2% (N-FMR vs. I-FMR vs. PM-FMR, respectively; P = 0.01). Five-year survival was 84.1% in N-FMR vs. 88.5% in I-FMR vs. 60.6% in the PM-FMR group, where it was the lowest (P <0.001). In multivariable modeling, PM-FMR increased mortality (hazard ratio [HR], 1.88 [1.05-3.37]; P = 0.03). I-FMR had no effect on mortality (HR, 0.67 [0.32-1.37]; P = 0.28). Five-year survival after excluding 30-day mortality was 86.3% vs. 89.4% vs. 66.0%; (N-FMR vs. I-FMR vs. PM-FMR, respectively; P = 0.02). PM-FMR increased late mortality (HR, 2.17 [1.14-4.15]; P = 0.01).Conclusions: In patients undergoing isolated AVR for AS, the presence of permanent moderate FMR significantly impacts 30-day and mid-term survival.