Dabic, Petar (59441990800)Petar (59441990800)DabicVucurevic, Bojan (58626374100)Bojan (58626374100)VucurevicSevkovic, Milorad (57191479099)Milorad (57191479099)SevkovicAndric, Dusan (59442737700)Dusan (59442737700)AndricPesic, Slobodan (58525670300)Slobodan (58525670300)PesicNeskovic, Mihailo (57194558704)Mihailo (57194558704)NeskovicBorovic, Sasa (12796337400)Sasa (12796337400)BorovicPetrovic, Jovan (57315862300)Jovan (57315862300)Petrovic2025-06-122025-06-122024https://doi.org/10.3390/jcm13226971https://www.scopus.com/inward/record.uri?eid=2-s2.0-85210449489&doi=10.3390%2fjcm13226971&partnerID=40&md5=4ced4c5c63e1f83b4729ca87b85d861chttps://remedy.med.bg.ac.rs/handle/123456789/846Background: The management of mitral regurgitation during aortic valve replacement remains a complex question. Secondary mitral regurgitation often improves post-aortic valve replacement without mitral valve surgery, but residual mitral regurgitation can significantly affect long-term outcomes. This study investigates the natural history of mitral regurgitation following isolated aortic valve replacement and identifies prognostic factors for persistent mitral regurgitation. Methods: A retrospective study was conducted on 108 patients who underwent isolated aortic valve replacement. Patients were categorized based on mitral regurgitation improvement. Additionally, patients were divided into patient-prosthesis mismatch and non-patient-prosthesis mismatch groups based on the aortic prosthesis. Preoperative and postoperative echocardiographic data were analyzed. Results: In total, 63% of patients showed mitral regurgitation improvement. The improved functional MR group showed significant reductions in peak and mean transvalvular pressure gradients. In contrast, the patient-prosthesis mismatch group had persistent mitral regurgitation improvement in 59.2% of patients. The non-patient-prosthesis mismatch group exhibited significant structural improvements and a reduction in mitral regurgitation severity in 68.6% of patients. Conclusions: The study shows that aortic valve replacement could significantly improve MR when patient-prosthesis mismatch is avoided. This approach maximizes hemodynamic outcomes, mitigates the risk of residual or worsening mitral regurgitation, and potentially reduces the need for additional mitral valve interventions. © 2024 by the authors.aortic stenosisaortic valve replacementmitral regurgitationpatient-prosthesis mismatch