Abstract 3282: Elevated Triglycerides, Not Cholesterol, Predict Bioprosthetic Pulmonary Valve Degeneration
Background: The role of lipids in accelerating native valve degeneration is controversial. Bioprosthetic pulmonary valves (BPV) are used frequently in adult patients (pt) with congenital heart disease (CHD). Whether hyperlipidemia hastens their degeneration remains uncertain.
Methods: A retrospective review of the adult CHD database at Mayo identified 136 pt (64 males) with conotruncal abnormalities who had 201 BPV implantations before 2002. Mean age at surgery was 24 ± 15 yr (range 1–68); 59 pt were <18 yr at initial BPV implantation alone (n=56) or within a conduit (n=79). Variables examined are listed in Table 1⇓. Additional variables were diabetes and aspirin or warfarin use. Serum lipid and calcium levels at the time of surgery and at last follow-up were categorically examined. End-points were BPV explantation or peak systolic gradient (PG) >50 mmHg. Risk of BPV degeneration was evaluated following initial implantation and reoperation.
Results: Of 136 pt, 55 needed BPV explantation after 1–26 yr (mn=12.4±5.8) and 30 developed a PG >50 mmHg after 3–25 yr (mn=11.5±4.9). Mean BPV survival was 9.1 ± 7.2 yr (range <1–31). BPV degeneration was unrelated to valve size or type, age at implantation, pulmonary artery pressure ≥ 40 mmHg (Table 1⇓), diabetes, hypercalcemia, or aspirin or warfarin use. Cholesterol levels did not influence BPV degeneration despite 18 pt having a total cholesterol ≥200 mg/dL. Hypertriglyceridemia (≥150 mg/dL) observed in 14 pt was a risk factor for developing a PG >50 mmHg (p = 0.035) but was not related to BPV explantation. No factors significantly affected BPV survival following 1 explantation (n=56) or ≥ 2 explantations (n=12).
Conclusion: Cholesterol does not influence BPV degeneration but pt with hypertriglyceridemia are 2.8 times more likely to develop severe BPV stenosis (PG >50 mmHg) after initial implantation. Valve durability is not affected by age at implantation or BPV type or size.