Abstract 9925: Mixed Aortic Valve Disease: Natural History and Predictors of Adverse Events

Abstract

Objectives: To determine freedom from symptoms and adverse events (AE) defined as aortic valve replacement (AVR) or death in patients (pt) with mixed aortic valve disease (MAVD). Methods: Reviewed pt with moderate/severe MAVD (moderate/severe aortic stenosis and regurgitation) at the Mayo Clinic from 1994-2013. Only asymptomatic pt with normal ejection fraction (>50%) and trileaflet aortic valves were included. Cox proportional-hazard models were used to determine predictors of AE. Event-free survival curves were generated with the Kaplan-Meier method. Results: We identified 213 pt (age=69±11 years, male=67%). AE occurred in 155 pt, and 71% of these AE occurred in moderate MAVD (peak velocity of 3 to 3.9 m/s). Mean follow-up was 10.1±3 years and time to AE was 2.9±2.1 years. Concomitant coronary artery bypass grafting (CABG) and/or aortic replacement during AVR was performed in 54/151 (36%). Early mortality was 0.7%. Freedom from AE was 30% and 15% at 5 and 10 years. Freedom from symptoms was 34% and 16% at 5 and 10 years. Predictors of AE were peak aortic velocity (hazard ratio [HR] 2.56 Confidence interval [CI] 2.24-2.93, p<0.0001) for every 1m/s increase in peak velocity, and having severe stenosis or regurgitation at presentation (HR 2.92; CI 2.73-3.14, p=0.001). Conclusion: MAVD had high rate of AE and development of symptoms, even in a subset of pt with only moderate MAVD. Peak aortic velocity and severe MAVD at presentation predict AE. Figure Legend: pVel: peak velocity group 1: moderate aortic stenosis and regurgitation Group ≥2: severe aortic stenosis or regurgitation