Outcome of Combined Stenotic and Regurgitant Aortic Valve Disease

Objectives This study sought to describe the natural history of combined stenotic and regurgitant aortic valve disease. Background Data on outcome and prognostic factors in combined aortic valve disease are scarce. Methods This study prospectively followed 71 consecutive asymptomatic patients (21 women, age 52 +/- 17 years) with at least moderate aortic stenosis in combination with at least moderate aortic regurgitation and preserved left ventricular function (ejection fraction >= 55%). Results During a median potential follow-up of 8.9 years, 50 patients developed an indication for aortic valve replacement and no cardiac deaths were observed. Overall event rates were high with an event-free survival for the entire patient population of 82 +/- 5%, 62 +/- 6%, 49 +/- 6%, 33 +/- 6%, and 19 +/- 5% at 1, 2, 3, 4, and 6 years, respectively. There was 1 operative and no post-operative deaths. Peak aortic jet velocity (AV-Vel) independently predicted event-free survival. Patients with an AV-Vel between 3 and 3.9 m/s had an event-free survival of 94 +/- 4%, 88 +/- 6%, 65 +/- 9%, and 51 +/- 9% after 1, 2, 4, and 6 years, respectively, compared with 92 +/- 4%, 67 +/- 7%, 38 +/- 8%, and 12 +/- 6% for patients with an AV-Vel between 4 and 4.9 m/s and 67 +/- 8%, 39 +/- 10%, 17 +/- 9%, and 0% for patients with an AV-Vel >= 5 m/s (p < 0.0001). Conclusions Asymptomatic patients with combined aortic valve disease can be safely followed until surgical criteria defined for aortic stenosis, aortic regurgitation, or the aorta are reached. However, high event rates can be expected even in younger patients and those with only moderate disease. AV-Vel, which reflects both stenosis and regurgitant severity, provides an objective and easily assessable predictive parameter. (J Am Coll Cardiol 2013;61:1489-95) (C) 2013 by the American College of Cardiology Foundation