Clinical Management and Long-Term Prognosis of Combined Left-Sided Valvular Heart Disease

In studies on left-sided valve disease, patients with combined lesions are generally excluded. We aimed to describe the clinical management and prognosis of patients with combined left-sided valve disease. From a single, tertiary care center, a total of 122 patients with combined left-sided valve disease of at least moderate severity were identified and compared with 143 controls with single-lesion valve disease (1VaD) of at least moderate severity. Endpoints were all-cause mortality and the combination of valve intervention and mortality. Overall survival for patients with two-lesion valve disease was significantly lower than that for patients with 1VaD (estimated 3-year survival: 52% versus 73%, P < 0.001). Compared with 1VaD, the combination of aortic stenosis and aortic regurgitation (AS/AR) was associated with a similar overall survival (hazard ratio (HR) (95% confidence interval (CI)): 0.83 (0.47-1.48), P = 0.53), the combination of AR and mitral regurgitation (AR/MR) with an intermediate survival (HR (95% CI): 1.76 (1.03-3.00). P = 0.039) and the combination of AS and MR (AS/MR) with the poorest survival (HR (95% CI): 3.28 (2.16-4.98), P < 0.001). At 2.2 years of follow-up, the majority of patients in all three groups were either dead or had received valve intervention (AS/AR: 72%, AR/MR: 64%, and AS/MR: 80%). Combined valve disease was relatively rare but was associated with a decreased overall survival. Survival depended on the specific combination of valve lesions, with AS/MR carrying the worst prognosis. The majority of patients in all groups were either dead or had valve intervention performed within 2.2 years.