Clinical outcomes of mild-to-moderate mixed aortic valve disease versus isolated aortic stenosis

Mixed aortic valve disease (MAVD), combining aortic stenosis (AS) and regurgitation (AR), is prevalent yet understudied at mild-to-moderate severity.

We aimed to compare clinical outcomes of mild-to-moderate MAVD versus isolated AS, hypothesizing more adverse effects due to dual hemodynamic stress.

This retrospective cohort study analysed 1590 patients (mean age 75.3 ± 12.2 years, 45% male) with mild-to-moderate AS (aortic valve area 1.0-2.0 cm²) and preserved left ventricular systolic function (LVEF ≥50%) at Queen Mary Hospital (2003-2021). Mild-to-moderate MAVD was defined as a combination of mild-to-moderate AS and mild-to-moderate AR (≤grade 2). Endpoints included all-cause mortality, aortic valve replacement (AVR), and major adverse cardiovascular events (MACE).

MAVD patients were younger (73.2 ± 13.2 vs 75.7 ± 12.0 years; p = 0.004) and less diabetic (14% vs 23%; p = 0.003) than those with isolated AS. MAVD exhibited greater LV dilation (LV end-diastolic diameter 4.39 ± 0.67 vs 4.15 ± 0.63 cm; p < 0.001) and hypertrophy (LV mass index 133.82 ± 41.48 vs 110.38 ± 28.87 g/m²; p < 0.001) than those with isolated AS. MAVD increased AVR risk by 42% (adjusted HR 1.42; 95% CI 1.01-1.99; p = 0.048) and MACE by 28% (adjusted HR 1.28; 95% CI 1.02-1.60; p = 0.035), with no mortality difference (adjusted HR 1.09; 95% CI 0.91-1.32; p = 0.4).

Mild-to-moderate MAVD is associated with more adverse LV remodelling and worse clinical outcomes-notably higher rates of AVR and MACE-than isolated AS of comparable severity. These findings challenge its benign perception, advocating closer surveillance to optimize care in this underrecognized population.