Abstract
Additional exploration is required to determine how to treat patients with moderate aortic regurgitation (AR) in rheumatic mitral valve (MV) surgery. This study compared clinical outcomes in patients undergoing non-surgical treatment (NT) of aortic valve (AV), aortic valvuloplasty (AVP), and aortic valve replacement (AVR). This multicenter, retrospective observational cohort study included 338 moderate AR patients undergoing rheumatic MV surgery from January 2015 to January 2024. We followed up with patients for a median of 43.4 months. Furthermore, more-than-mild aortic valve dysfunction (AVD) in the follow-up period was our primary outcome. Our secondary outcomes were all-cause mortality and cardiac valve reoperation before discharge and during follow-up. We classified patients into three groups, namely, NT (n = 128), AVP (n = 91), and AVR (n = 119) groups, respectively. Moreover, 33.0%, 30.1%, and 3.9% of patients achieved our primary outcome, while 4.2%, 5.6%, and 9.6% of them attained our secondary outcomes in the three groups, respectively. We observed that fewer patients from the AVR group had achieved the primary outcome than those in the NT [adjusted relative risk (RR), 0.41; 95% confidence interval (CI), 0.21–0.68; p = 0.002] and AVP groups (adjusted RR, 0.14; 95% CI, 0.04–0.43; p = 0.002), respectively. The secondary outcomes did not significantly differ among the three groups. Without increasing surgical risks, the concurrent AVR significantly improves AV status in moderate AR patients undergoing rheumatic MV surgery throughout follow-up. None or mild AVD was observed in many patients from the NT group during the follow-up, thereby warranting the delay of surgery for AV.
Data availability
The anonymous raw data that support the findings of this study are available from corresponding author (Wenjian Jiang, email: [jiangwenjian@ccmu.edu.cn](mailto: jiangwenjian@ccmu.edu.cn) ) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are available from the authors upon reasonable request and with permission of Beijing An Zhen Hospital.
Abbreviations
- ACC:
-
Aortic cross clamp
- AF:
-
Atrial fibrillation
- AR:
-
Aortic regurgitation
- AS:
-
Aortic stenosis
- AV:
-
Aortic valve
- AVD:
-
Aortic valve dysfunction
- AVP:
-
Aortic valvuloplasty
- AVR:
-
Aortic valve replacement
- CAD:
-
Coronary artery disease
- CI:
-
Confidence interval
- COR:
-
Class of recommendation
- CPB:
-
Cardiopulmonary bypass
- HR:
-
Hazard ratios
- LA:
-
Left atrium
- LV:
-
Left ventricular
- LVEDD:
-
Left ventricular end-diastolic dimension
- LVESD: Left ventricular end-systolic dimension MR:
-
Mitral regurgitation
- MS:
-
Mitral stenosis
- MV:
-
Mitral valve
- NT:
-
Non-surgical treatment
- NYHA:
-
New York Heart Association
- OR:
-
Odds ratio
- PAH:
-
Pulmonary artery hypertension
- RHD:
-
Rheumatic heart disease
- RR:
-
Relative risk
- SD:
-
Standard deviation
- TR:
-
Tricuspid regurgitation
- TTE:
-
Transthoracic echocardiography
- VCW:
-
Vena contracta width
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Acknowledgements
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Funding
Beijing Anzhen Hospital Major Science and Technology Innovation Fund (No. KCZD202203, KCQY202201). National Science Foundation of China (No. 82422007, 82241205, 82170487), Beijing Natural Science Foundation.
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(I) Conception and design: Wen-jian Jiang, Chuang Liu; (II) Administrative support: Hong-jia Zhang, Wen-jian Jiang, Xiao-long Wang, and Mao-zhou Wang; (III) Provision of study materials or patients: Xiao-long Wang, Wen-jian Jiang, and Hong-jia Zhang; (IV) Collection and assembly of data: Chuang Liu, Zhou Liu, Jia-jun Liang, Song-hao Jia, Mao-zhou Wang, and Pei-yi Liu; (V) Data analysis and interpretation: Chuang Liu, Zhou Liu, Jia-jun Liang, Ming-xuan Zhang, Mao-zhou Wang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
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The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by ethics board of Beijing An Zhen Hospital (Institutional Review Board document KS2022064). The clinical registration number of this study is ChiCTR2200067151. Informed consent was waived because of the retrospective nature.
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Liu, C., Liu, Z., Liang, Jj. et al. Clinical outcomes and management strategies for moderate aortic regurgitation in patients undergoing rheumatic mitral valve surgery. Sci Rep (2026). https://doi.org/10.1038/s41598-026-37045-5
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DOI: https://doi.org/10.1038/s41598-026-37045-5
