%0 Journal Article
%T Aortic valve replacement for moderate aortic stenosis during mitral surgery improves survival free from severe stenosis.
%A Weingarten N
%A Rekhtman D
%A Iyengar A
%A Song C
%A Patel M
%A Atluri P
%J Asian Cardiovasc Thorac Ann
%V 31
%N 6
%D 2023 Jul 7
%M 37415529
暂无%R 10.1177/02184923231186850
%X <B>BACKGROUND: </B>Optimal management of moderate aortic stenosis during surgery for another indication is unclear. We assessed the effects of surgical aortic valve replacement for moderate aortic stenosis during mitral surgery.<BR><B>METHODS: </B>An institutional mitral surgery database was queried for patients with preoperative moderate aortic stenosis. Patients were stratified by whether they underwent concomitant surgical aortic valve replacement. Morbidity was analyzed using Student's t tests, Wilcoxon rank sum, chi-squared, and Fisher's exact tests. Survival was analyzed using Kaplan-Meier estimation and Cox regression.<BR><B>RESULTS: </B>Of 85 mitral surgery recipients with moderate aortic stenosis from 2012 to 2019, 62 (73%) underwent concomitant surgical aortic valve replacement. Surgical aortic valve replacement recipients were more likely to have bicuspid (11% vs. 0%, p  =  0.019) or rheumatic (18% vs. 0%, p  =  0.019) aortic valves, and to undergo mitral repair (32% vs. 9%, p  =  0.028). Groups did not differ with respect to mitral etiology, New York Heart Association class, or cardiac intervention history (p > 0.05). Postoperatively, groups had similar stroke and gastrointestinal bleed rates (3% vs. 0% and 2% vs. 0% in the surgical aortic valve replacement vs. no surgical aortic valve replacement group respectively, both p > 0.99). Five-year survival free from severe aortic stenosis was higher in the surgical aortic valve replacement group (66% vs. 17%, p  =  0.002). Surgical aortic valve replacement protected against the composite of death and progression to severe aortic stenosis at 5 years (hazard ratio: 0.32, p  =  0.003).<BR><B>CONCLUSIONS: </B>Surgical aortic valve replacement for moderate aortic stenosis at time of mitral surgery is a well-tolerated strategy to reduce aortic disease progression.