{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:48:08Z","timestamp":1787870888592,"version":"build-2784847793"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Mitral regurgitation (MR) is commonly experienced by patients with aortic insufficiency (AI), and in its mild form, it is considered benign. However, the progression of concomitant mild regurgitation after the aortic valve surgery (AVS) for AI is poorly characterized. The current study aimed to define the long-term outcomes of MR after surgery and identify the risk factors involved in deterioration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients presenting with moderate\/severe AI and concomitant mild MR (<jats:italic>n<\/jats:italic> = 347) between January 2013 and December 2021 were enrolled. MR grade was assessed by transthoracic echocardiography during the follow-up, and deterioration is defined as an increase in grade to moderate or severe MR from the previous follow-up echocardiography. Analysis of risk factors for early mortality, MR deterioration, and long-term mortality was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 278 patients (84.8%) among 328 survivors had at least one follow-up echocardiography, and complete follow-up occurred for 316 patients (96.3%). Mild MR improved to trivial or none in 194 patients (69.8%), progressed to persistent mild MR for 74 patients (26.6%), and deteriorated for 10 patients (3.6%). Preoperative atrial fibrillation [odds ratio (OR), 23.09; 95% confidence interval (CI), 4.35\u2013122.54] and rheumatic AI (OR, 11.61; 95% CI, 1.26\u2013106.85) were shown to be independent risk factors for MR deterioration by generalized linear mixed analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Progression of concomitant mild MR is rare in patients with AI after AVS. However, rheumatic AI and preoperative atrial fibrillation increase the probability of MR deterioration. Careful follow-up for this cohort of patients is recommended.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.1035490","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T05:00:49Z","timestamp":1674190849000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The fate of concomitant mild mitral regurgitation in aortic insufficiency: A neglected subject"],"prefix":"10.3389","volume":"9","author":[{"given":"Hao","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiming","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghai","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suyun","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenhui","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.jacc.2020.05.051","article-title":"Concomitant mitral regurgitation in patients with chronic aortic regurgitation","volume":"76","author":"Yang","year":"2020","journal-title":"J Am Coll Cardiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3404","DOI":"10.1053\/j.jvca.2021.01.003","article-title":"Mitral regurgitation in patients with coexisting chronic aortic regurgitation: an evidence-based narrative review","volume":"35","author":"Patel","year":"2021","journal-title":"J Cardiothorac Vasc Anesth."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1126","DOI":"10.4244\/EIJ-E-21-00009","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"17","author":"Vahanian","year":"2022","journal-title":"EuroIntervention."},{"key":"B4","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/j.jtcvs.2013.09.030","article-title":"Management of concomitant mild to moderate functional mitral regurgitation during aortic valve surgery for severe aortic insufficiency","volume":"148","author":"Lim","year":"2014","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.athoracsur.2011.02.065","article-title":"Fate of functional mitral regurgitation and predictors of persistent mitral regurgitation after isolated aortic valve replacement","volume":"92","author":"Joo","year":"2011","journal-title":"Ann Thorac Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1016\/j.ejcts.2011.03.036","article-title":"Aortic valve replacement for aortic stenosis in patients with concomitant mitral regurgitation: should the mitral valve be dealt with?","volume":"40","author":"Harling","year":"2011","journal-title":"Eur J Cardiothorac Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography","volume":"32","author":"Mitchell","year":"2019","journal-title":"J Am Soc Echocardiogr."},{"key":"B8","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1136\/hrt.2010.212282","article-title":"Management of multiple valve disease","volume":"97","author":"Unger","year":"2011","journal-title":"Heart."},{"key":"B9","doi-asserted-by":"publisher","first-page":"W14","DOI":"10.4244\/EIJV11SWA3","article-title":"Multiple valve disease - 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