Characteristics, management, and outcomes of patients with multiple native valvular heart disease: a substudy of the EURObservational Research Programme Valvular Heart Disease II Survey. (2nd May 2022)

• Record Type: Journal Article
• Authors: Tribouilloy, Christophe; Bohbot, Yohann; Kubala, Maciej; Ruschitzka, Frank; Popescu, Bogdan; Wendler, Olaf; Laroche, Cécile; Bartha, Elektra; Ince, Huseyin; Simkova, Iveta; Vahanian, Alec; Iung, Bernard
• Is Part Of: European heart journal. Volume 43:Number 29(2022)
• Page Start: 2756
• Page End: 2766
• Publication Date: 2022-05-02
• Subjects: Multiple valvular heart disease -- Native valvular heart disease -- Survival -- Management -- Cardiac surgery -- Valvular Heart Disease II Survey; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac209
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: To assess the characteristics, management, and survival of patients with multiple native valvular heart disease (VHD). Methods and results: Among the 5087 patients with ≥1 severe left-sided native VHD included in the EURObservational VHD II Survey (maximum 3-month recruitment period per centre between January and August 2017 with a 6-month follow-up), 3571 had a single left-sided 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 1153 patients (22.7%) had ≥2 severe native VHDs (left-sided and/or tricuspid regurgitation, Group C). Patients with multiple VHD (Groups B and C) were more often women, had greater congestive heart failure (CHF) and comorbidity, higher left atrial volumes and pulmonary pressures, and lower ejection fraction than Group A patients (all P ≤ 0.01). During the index hospitalization, 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 or C (both P < 0.001), even after adjustment for age, sex, body mass index, and Charlson index [hazard ratio (HR) 95% confidence interval (CI) 1.62 (1.10–2.38) vs. Group B and HR 95% CI 1.72 (1.32–2.25) vs. Group C]. Groups B and C had more CHF at 6 months than Group A (both P < 0.001). Factors associated with mortality in Group C were age, CHF, and comorbidity (all P < 0.010). Conclusion: 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 6 months than single VHD, yet with lower rates of surgery. Structural Graphical Abstract: Structural Graphical Abstract Characteristics, survival and management differences in patients with multiple valvular heart disease.