Valvular heart disease (VHD) is a leading cause of mortality and morbidity in Europe. It is projected that the number of patients with valve disease will increase due to aging population and the lack of effective preventive strategies for degenerative valve disease. Specifically, it is thought that the number of patients with aortic stenosis (AS) will increase two- to threefold in the next 50 years. Per the EURObservational Research Programme, it is projected that over the next 60 years, the bulk of moderate to severe VHD will be undiagnosed in the UK population.

The first look at VHD in Europe was gleaned from the Euro Heart Survey on Valvular Heart Disease.¹ This included 5,001 patients between April and July, 2001, from 92 centers in 25 countries. During this period, 1,269 valve interventions were performed. A total of 3,547 patients had native valve disease in descending order of prevalence: AS, mitral regurgitation (MR), multiple valve involvement, aortic regurgitation (AR), mitral stenosis (MS), and right-sided valvular involvement. Regarding etiology, degenerative valve disease is by far the most frequent in AS, MR, and AR. Endocarditis is still a serious concern in AR and MR. An ischemic origin is present in 7.3% of MR. Patients with AS were older, with an average age of 69 ± 12 years. Patients with MR had an average age of 65 ± 14 years. Patients with AR had an average age of 58 ± 16 years. Patients with MS were an average age of 58 ± 13 years.

The management of patients with severe symptomatic AS in elderly patients (>75 years) was also evaluated. There were 398 patients with AS, and severe AS was noted in 284 of those patients. Of those patients, 216 had symptoms, and 67% required an intervention. The reasons for the nonintervention in patients with single valve disease was regression of symptoms under medical therapy, end-stage renal disease, symptoms attributed to coronary artery disease, and recent myocardial infarction. Aside from cardiac causes, the presence of at least one extra-cardiac cause was considered to contraindicate surgery in 55.3% of cases. The most frequent reasons were old age (27.6%, as a sole reason in 1.3%), chronic obstructive pulmonary disease (13.6%), renal failure (6.1%), and short life expectancy (19.3%).

This survey confirmed that it was possible to perform such a survey in a large number of European countries, and it provided a unique contemporary data set on the presentation and management of patients with VHD. The findings in this survey showed that VHD was mostly degenerative in origin, with AS being the most frequent. The patients were often elderly with a number of cardiovascular risk factors and comorbidities. In accordance with the existing guidelines, coronary angiography is frequently performed in the evaluation of these patients. However, there was a trend toward overuse of catheterization and insufficient use of exercise testing. Intervention consisted mostly of valve replacement for aortic valve disease and conservative techniques in mitral valve disease. In keeping with the characteristics of the population, combined procedures were often necessary. Finally, the survey revealed that there was an important need for further trials, in particular in patients who have undergone previous operation, who represented an important sub-group.

Since the Euro Heart Survey on Valvular Heart Disease in 2001, management of valve disease had evolved. European guidelines were published in 2007, which were updated in 2012.² Less-invasive treatments such as transcatheter aortic valve replacement for AS and transcatheter edge-to-edge repair for MR are being used. There is improved knowledge of deploying the different interventions. Finally, there are dedicated heart valve clinics with a multidisciplinary heart team approach for complex cases.

This evolution led to creation of Valvular Heart Disease II (VHDII) Survey.³ The VHDII registry's primary objectives follow:

1. Analyze existing practices in the management of patients with severe native heart valve disease or any previous valvular intervention.
2. Compare these practices with existing European Society of Cardiology (ESC) guidelines.
3. Evaluate changes in the practices since the first European survey on VHD performed in 2001.

The study design is an international, prospective, longitudinal, multicentre, observational study of patients presenting to hospital or outpatient clinics. This includes patients 18 or older with severe native valve disease according to the ESC and European Association for Cardio-Thoracic Surgery 2012 guidelines, or a previous valvular intervention. About 150-200 centers are expected to enroll 5,000 patients.

References

1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003;24:1231-43.
2. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012;42:S1-44.
3. Valvular Heart Disease II (VHDII) Survey (European Society of Cardiology website). 2018. Available at: https://www.escardio.org/Research/Registries-&-surveys/Observational-registry-programme/valvular-heart-disease-ii-vhdii-registry. Accessed 05/17/2017.

Keywords: Heart Valve Diseases, Mitral Valve Insufficiency, Aortic Valve Insufficiency, Aortic Valve Stenosis, Endocarditis, Coronary Angiography, Mitral Valve Stenosis, Transcatheter Aortic Valve Replacement, Coronary Artery Disease, Prospective Studies, Thoracic Surgery, Mitral Valve, Life Expectancy, Risk Factors, Heart Defects, Congenital, Comorbidity, Kidney Failure, Chronic, Pulmonary Disease, Chronic Obstructive, Catheterization, Renal Insufficiency, Ambulatory Care Facilities, Myocardial Infarction

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