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Published on: May 21, 2017
Preoperative cholesterol levels do not predict explant for structural valve deterioration in patients undergoing
Christian N Gring1, Penny Houghtaling, Gian M Novaro
1Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Insights
Preoperative cholesterol levels do not predict structural valve deterioration (SVD) after bioprosthetic aortic valve replacement (AVR). Further research is needed on long-term hypercholesterolemia and statin therapy
Area of Science:
- Cardiology
- Biomaterials Science
- Clinical Research
Background:
- Structural valve deterioration (SVD) is the primary cause of bioprosthetic heart valve failure.
- Hypercholesterolemia is a known risk factor for coronary artery disease and may influence SVD.
- Investigating preoperative cholesterol's role in SVD is crucial for patient management.
Purpose of the Study:
- To examine the relationship between preoperative cholesterol levels and SVD in patients undergoing bioprosthetic aortic valve replacement (AVR).
Main Methods:
- A cohort of 7,150 patients who underwent bioprosthetic AVR between 1975 and 2002 was analyzed.
- Preoperative and postoperative data were collected from a prospective database.
- Multivariable risk factor analysis was employed to identify predictors of SVD, with explantation for SVD as the primary endpoint.
Main Results:
- Preoperative total, HDL, and LDL cholesterol levels did not predict SVD.
- Younger age, greater body weight, elevated serum creatinine, and pericardial valve use were associated with SVD.
- No traditional cardiovascular risk factors were found to predict SVD.
Conclusions:
- Preoperative cholesterol levels are not predictive of SVD in patients receiving bioprosthetic AVR.
- The impact of long-term hypercholesterolemia and statin therapy on SVD warrants further investigation.
Background And Aim Of The Study:
Structural valve deterioration (SVD) is the most common cause of bioprosthetic valve failure. Coronary disease risk factors, including hypercholesterolemia, might predict SVD. Here, the relationship was examined between preoperative cholesterol levels and SVD in patients undergoing bioprosthetic aortic valve replacement (AVR).
Methods:
A total of 7,150 patients (mean age 68 +/- 12 years) was identified who underwent bioprosthetic AVR at the Cleveland Clinic Foundation, between January 1975 and December 2002. Preoperative and postoperative variables were retrieved from a prospective, computerized database. A parametric method was used to estimate the distribution of valve explants; a multivariable risk factor model was then developed to include patient demographics, cardiac and non-cardiac comorbidities, valve type and interactions. The primary end-point was explant for SVD. All explants were examined, and observations were censored at the time of any explant or death. Bootstrap analysis was used to validate the model.
Results:
Among 7,150 patients, 208 had explants for SVD. Mean preoperative total cholesterol (TC) was 203 +/- 48 mg/dl, HDL-cholesterol 45 +/- 15 mg/dl, and LDL-cholesterol 121 +/- 41 mg/dl. The average follow up was 3.7 years, and 1,169 patients (16%) were followed for more than eight years. In multivariable analysis, only younger age (p < 0.0001), greater body weight (p < 0.0001), elevated serum creatinine level (p = 0.0004) and use of a pericardial valve (p = 0.04) predicted SVD. Neither preoperative cholesterol nor its fractions predicted valve explant for SVD (log-rank p = 0.19) Moreover, no cardiovascular risk factors were predictive of SVD.
Conclusion:
Preoperative cholesterol levels do not predict SVD in patients undergoing bioprosthetic AVR. Whether long-term hypercholesterolemia or statin therapy impacts SVD requires further investigation.
