title: Outcome of combined stenotic and regurgitant aortic valve disease.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20,Vienna, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Zilberszac
authors.forename: Harald
authors.initials: H
authors.lastname: Gabriel
authors.forename: Michael
authors.initials: M
authors.lastname: Schemper
authors.forename: David
authors.initials: D
authors.lastname: Zahler
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosenhek
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D001317:Austria; D015331:Cohort Studies; D015897:Comorbidity; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011475:Prosthesis Failure; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome