Materials and Methods
Study Population
From January 1, 2010 to December 31, 2016, 241 patients received mitral valve repair/replacement(except for simultaneous aortic valve surgery)in Zhujiang Hospital of Southern Medical University. We classified all valvular lesions into mild, moderate and severe strictly according to the guidelines. Since the purpose of this study was to investigate the long-term effects of mitral valve surgery on the aortic valve, we also excluded patients who died within 30 days of surgery (n=6), patients with significant progression of AVD within 30 days after surgery (n=7, The progression of these patients may be due to the direct factors of surgery) and patients who were followed for less than 2 years (n=84). Finally, 144 eligible patients were selected for the study. A flow diagram of included and excluded patients is provided in the Figure 1. Demographic, clinical, and perioperative data of the patients were collected. Patients were examined by transthoracic echocardiography before surgery, within 2 weeks after surgery, 1 month, 2 months, and 6 months and then yearly for at least 2 years after discharge (the average follow-up time was 1554.72±759.03 days). According to the results of follow-up echocardiography of the aortic valve, patients were divided into a progression group and a non-progression group. Those who meet the following conditions were defined as the progression group (n=25, 17.36%): 1. The follow-up of no or mild AVD progressed to moderate or severe aortic valve disease; 2. The follow-up of moderate AVD progressed to severe. The non-progression group(n=119, 82.64%) was defined as: until the last follow-up echocardiography, there was no newly identified moderate AVD or no progression of AVD which was originally mild to moderate. The data collection ended in December 2019.