Functional mitral regurgitation and reverse left ventricular remodeling following surgical correction of chronic aortic regurgitation

Objective. To evaluate reverse myocardial remodeling in patients with severe left ventricular dilatation associated with chronic aortic insufficiency (AI) depending on functional mitral regurgitation (MR) and surgical approach. Material and methods. The study included 80 patients with left ventricular end-diastolic volume (LVEDV) ≥250 ml due to chronic AI with functional MR. Patients were divided into 3 groups: group 1 MR grade<2 without mitral valve (MV) repair (n=38), group 2 MR grade ≥2 without MV repair (n=22), group 3 MR grade ≥2 with MV repair (n=20). Surgical treatment of AI was performed using the following techniques: David procedure, Bentall-DeBono procedure, aortic valve replacement (AVR), isolated aortic leaflet repair. The study was conducted across multiple centers. Transthoracic echocardiography was used to assess LV reverse remodeling and dynamics of functional MR. Assessments were performed preoperatively, 7—10 days and 1 year after surgery. Results. MR regressed in all groups at all follow-up stages (p<0.001) regardless of MV repair strategy. No significant differences were found in early postoperative reverse remodeling of LVEDV among all groups (p=0.611). No significant postoperative between-group differences in LV end-systolic volume reduction were detected (p=0.106). Five-year freedom from MR grade >1—2 was 95.8% in the MR grade<2 group, 85.2% in the MR grade ≥2 without MV repair group, and 71.1% in the MR grade ≥2 with MV repair group. Conclusion. Isolated correction of chronic AI in patients with functional MR grade ≥2 achieves 100% freedom from MR grade >2 throughout 5 postoperative years.