Background: Valvular heart disease (VHD) is an important cause of mortality and morbidity
and has been subject to important changes in management. The VHD II survey was designed
by the EURObservational Research Programme of the European Society of Cardiology to
analyze actual management of VHD and to compare practice with guidelines. Methods:
Patients with severe native VHD or previous valvular intervention were enrolled prospectively
across 28 countries over a 3-month period in 2017. Indications for intervention were
considered concordant if the intervention was performed or scheduled in symptomatic
patients, corresponding to Class I recommendations specified in the 2012 European
Society of Cardiology and in the 2014 American Heart Association/American College
of Cardiology VHD guidelines. Results: A total of 7247 patients (4483 hospitalized,
2764 outpatients) were included in 222 centers. Median age was 71 years (interquartile
range, 62-80 years); 1917 patients (26.5%) were >= 80 years; and 3416 were female
(47.1%). Severe native VHD was present in 5219 patients (72.0%): aortic stenosis in
2152 (41.2% of native VHD), aortic regurgitation in 279 (5.3%), mitral stenosis in
234 (4.5%), mitral regurgitation in 1114 (21.3%; primary in 746 and secondary in 368),
multiple left-sided VHD in 1297 (24.9%), and right-sided VHD in 143 (2.7%). Two thousand
twenty-eight patients (28.0%) had undergone previous valvular intervention. Intervention
was performed in 37.0% and scheduled in 26.8% of patients with native VHD. The decision
for intervention was concordant with Class I recommendations in symptomatic patients
with severe single left-sided native VHD in 79.4% (95% CI, 77.1-81.6) for aortic stenosis,
77.6% (95% CI, 69.9-84.0) for aortic regurgitation, 68.5% (95% CI, 60.8-75.4) for
mitral stenosis, and 71.0% (95% CI, 66.4-75.3) for primary mitral regurgitation. Valvular
interventions were performed in 2150 patients during the survey; of them, 47.8% of
patients with single left-sided native VHD were in New York Heart Association class
III or IV. Transcatheter procedures were performed in 38.7% of patients with aortic
stenosis and 16.7% of those with mitral regurgitation. Conclusions: Despite good concordance
between Class I recommendations and practice in patients with aortic VHD, the suboptimal
number in mitral VHD and late referral for valvular interventions suggest the need
to improve further guideline implementation.
