Abstract 15337: Hypercholesterolemia is a Risk Factor for Aortic Bioprosthetic Valve Degeneration
BACKGROUND. Structural valve degeneration (SVD) is the major cause of bioprosthetic valve failure. Recent retrospective studies have reported an association between atherosclerotic risk factors and the development of SVD. The objective of this prospective study was to identify the clinical and metabolic determinants of bioprosthetic SVD identified by Doppler-echocardiography.
METHODS AND RESULTS. Two hundred and three (203) consecutive patients with an aortic bioprosthetic valve were recruited and underwent a Doppler-echocardiographic exam, a multi-detector computed tomography (CT) for bioprosthesis calcification assessment and a complete plasma glycemic and lipid profile. Exclusion criteria were: 1-Presence of perivalvular regurgitation, 2- Significant mitral valve disease, 3- Subaortic obstruction, 4-Left ventricular ejection fraction<50%. SVD was defined as an increase in mean transprothetic gradient ≥ 10mmHg and/or a worsening of transprosthetic regurgitation ≥ 1/3 degree between 1-year and last follow-up (mean follow-up time was 8±3 years). Forty-two (42) pts (20%) were identified with SVD. Patients with SVD had significantly (p=0.05) higher CT calcification deposit within bioprosthetic valve leafLets compared to those with no SVD (196±34mm3 vs. 71±37 mm3). Patients with SVD had significantly higher serum total cholesterol levels (4.6±1.1mmol/l vs. 4.1 ±0.9mmol/l, p=0.03), higher LDL-cholesterol levels (2.6± 1.0mmol/l vs. 2.1 ±0.7mmol/l, p=0.02), and tended to have higher oxidized-LDL cholesterol levels (p=0.08) and higher Apo-B levels (p=0.08) compared to those with no SVD. On multivariate analysis, only serum LDL-cholesterol (OR=1.69, 95%CI: 1.14 to 2.5, p=0.009) was an independent predictor of SVD.
CONCLUSION. This study demonstrates a strong association between hypercholesterolemia and structural degeneration of bioprosthetic valves. Randomized trials are needed to determine if lipid-lowering therapy prescribed at the time of aortic valve replacement could prevent or slow bioprosthetic valve degeneration.
- © 2011 by American Heart Association, Inc.