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Patient Risk Factors for Bioprosthetic Aortic Valve Degeneration: A Systematic Review and Meta-Analysis
Ayame Ochi1, Kevin Cheng2, Bing Zhao1
1Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia.
Heart, Lung & Circulation
|December 17, 2019
Summary
Younger age, larger body surface area, patient-prosthesis mismatch, and smoking increase the risk of structural valve degeneration (SVD) in bioprosthetic aortic valves. Older age is protective against SVD.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Statistics
Background:
- Structural valve degeneration (SVD) is a primary concern for bioprosthetic aortic valves.
- Key risk factors contributing to SVD remain incompletely understood, complicating valve selection.
- Identifying modifiable and non-modifiable risk factors is crucial for improving bioprosthetic valve durability.
Purpose of the Study:
- To systematically review and meta-analyze existing literature to identify risk factors for SVD in aortic bioprostheses.
- To estimate the pooled effect sizes of identified risk factors to inform clinical decision-making.
- To provide evidence-based insights for selecting appropriate bioprosthetic valves in aortic valve replacement surgery.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed, Scopus, and Web of Science databases for relevant observational studies.
- Extracted hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals (CI); employed random-effects model for pooled estimates.
Main Results:
- Included 29 observational studies with 25,490 patients; 981 developed SVD over a mean 18.5-year follow-up.
- Identified four significant factors influencing SVD: younger age (protective), increased body surface area (risk), patient-prosthesis mismatch (risk), and smoking (risk).
- Specific risk estimates: Age (HR 0.91 [0.89, 0.94]), BSA (HR 1.77 [1.04, 3.01]), PPM (HR 1.95 [1.56, 2.43]), Smoking (HR 2.28 [1.37, 3.79]).
Conclusions:
- Younger age, patient-prosthesis mismatch, increased body surface area, and smoking are significant risk factors for aortic bioprosthetic SVD.
- These factors should be carefully considered during the selection of bioprosthetic valves for aortic valve replacement.
- Accelerated transvalvular flow may be a common pathophysiological mechanism in SVD, warranting future research into high cardiac output states.
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