Abstract 16923: Determinants of Outcome in Adults with Asymptomatic Moderate Mixed Aortic Valve Disease

Abstract

Background: Management of patients with asymptomatic mixed aortic valve disease (MAVD) remains uncertain. We sought to evaluate the outcomes of these pts.

Methods: Between 2000 and 2005, we identified 190 pts with MAVD who did not undergo surgery at the initial evaluation, and obtained follow-up in all. Moderate MAVD comprised mild or moderate aortic stenosis (AS, AVA≥1 cm2) and moderate or mild aortic regurgitation (AR, grade≤2). The effect of the clinical and ECG variables on outcome, censored at aortic valve surgery (AVR) and mortality, were studied in a Cox proportional-hazards model. To investigate the role of follow-up echo, we analyzed a subgroup of 112 pts (66±13 years, 69 men) with follow-up echo within the first year.

Results: Over a mean of 5.5±3.1 (range 1 to 10) years of follow-up, 99(52%) pts underwent AVR and 39(20%) died. The strongest independent associations of surgery were age, baseline ejection fraction(EF), baseline and follow-up AVA and gradients (Table). Angina, dyspnea or syncope developed during the follow-up in 78(79%) prior to AVR. Coronary artery disease (CAD) at baseline was present in 25 pts(22%), and developed in 19(10%) during follow-up; CAD was not associated with surgery. The strongest independent associations of mortality were age, baseline and follow-up EF and gradient.

Conclusion: Most pts with asymptomatic moderate MAVD will need AVR within 5 years. Results of follow-up echocardiography appear to be important associations of both surgical decision-making and mortality.