Characteristics, management and outcomes of patients with multiple native valvular heart disease: A substudy of the EURObservational research programme valvular heart disease II survey

Abstract

Few data are available on patients with multiple native valvular heart disease (VHD). To assess the characteristics, management, and survival of patients with multiple native VHD. Among the 5087 patients with ≥ 1 severe left-sided native VHD included in the EURObservational VHD II Survey, 3,571 had a single VHD (group A, 70.2%), 363 had one severe left-sided VHD with moderate VHD of the other ipsilateral valve (group B, 7.1%) and 1,153 patients (22.7%) had ≥ 2 severe native VHDs (left-sided and/or tricuspid regurgitation [TR], group C). Patients with multiple VHD (groups B and C) were more often women, had greater congestive heart failure and comorbidity, higher left-atrial volumes and pulmonary pressure, and lower ejection than group A patients (all P ≤ 0.003). During the survey period, 36.7% of group A ( n = 1312), 26.7% of group B ( n = 97), and 32.7% of group C ( n = 377) underwent valvular intervention ( P < 0.001). Six-month survival was better for group A than for group B ( P = 0.0002) or C ( P < 0.0001). After adjustment for age, sex, body-mass index and Charlson index, group B [adjusted HR(95%CI) = 1.62(1.10–2.38)] and group C [adjusted HR(95%CI) = 1.72(1.32–2.25)] experienced greater six-month mortality than group A. Group B and C patients were more often diagnosed with heart failure during the six-month follow-up than those of group A (both P < 0.001) ( Fig. 1 ). Multiple VHD is common, encountered in nearly 30% of patients with left-sided native VHD, and associated with greater cardiac damage and leads to higher mortality and more heart failure at six months than single VHD, yet with lower rates of surgery.