Tabriz University of Medical Sciences Journal of Cardiovascular and Thoracic Research 2008-5117 17 3 2025 09 28 Iatrogenic aortic valve injury following mitral valve surgery: A systematic review 153 158 10.34172/jcvtr.025.33350 EN Michele D’Alonzo https://orcid.org/0000-0002-3971-4145 Besart Cuko https://orcid.org/0000-0001-6207-7124 Julien Ternacle https://orcid.org/0000-0002-9629-5864 Olivier Busuttil https://orcid.org/0009-0008-6396-9173 Nabil Dib Serge Sicouri https://orcid.org/0000-0002-1822-768X Carlo De Vincentiis https://orcid.org/0000-0002-9945-0057 Louis Labrousse https://orcid.org/0000-0001-8542-9049 Thomas Modine https://orcid.org/0000-0003-4169-3766 Basel Ramlawi https://orcid.org/0000-0002-0471-0910 Massimo Baudo https://orcid.org/0000-0003-3754-6704 REVIEW 10.34172/jcvtr.025.33350 2024 09 10 2025 05 28 Iatrogenic aortic regurgitation after mitral valve surgery is the consequence of either direct stitching-related perforation or indirect distortion of aortomitral fibrous continuity by the mitral ring/prosthesis. This review aims at describing the reported cases of iatrogenic aortic valve regurgitation following mitral valve surgery, focusing primarily on its management. PubMed, ScienceDirect, DOAJ, and Cochrane databases were searched from inception until December 2023 for case reports and case series describing iatrogenic aortic valve regurgitation following mitral valve surgery. The literature review found 17 articles describing 20 cases of new onset aortic valve regurgitation after mitral valve surgery. Among them, 5 patients did not undergo reoperation, either due to medical decision or patient refusal. The non-coronary cusp was predominantly affected (11 cases), the left coronary cusp involved in 4 cases, and a mixed mechanism occurred in 5 cases. Subsequent surgical interventions included aortic valve replacements in 5 cases and aortic valve repair in 4 cases. A suggested management decision algorithm is finally proposed. Iatrogenic aortic valve regurgitation after mitral valve surgery remains an unfortunate complication. Attention should be given to prevent this complication. Intraoperative transesophageal echocardiography plays a crucial role for early detection. Management strategies vary from medical therapy to surgical interventions. The reparative strategy requires a surgical procedure associated with significant mortality.