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At least 577 records · Page 32Linked to original sources
PubMed2005

Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT).

OBJECTIVE: To examine risk factors for major paravalvular leak (PVL) events after mechanical heart valve replacement. METHODS: We analyzed outcome of 807 patients randomized into the Artificial Valve Endocarditis Reduction Trial (AVERT). The mean follow-up time was 30.6 months and 21 major PVL events were reported. Three additional major PVL events associated with endocarditis were excluded from analysis. All baseline medical history variables, as well as operative parameters (including use of pledgets and suture technique) were examined using Cox regression. RESULTS: Major PVL was reported after 11 aortic, 9 mitral, and 1 double valve replacement. 6/404 (1.5%) patients with conventional valves experienced a major PVL event versus 15/403 (3.7%) in the Silzone group. 10/172 (5.8%) patients with valve suture technique without pledgets experienced a major PVL event versus 11/635 (1.7%) patients with pledgets. Final multivariable model showed that only suture technique without pledgets (p=0.005) was an independent significant risk factor for major PVL events. Silzone cuff showed a strong trend (p=0.055). CONCLUSIONS: Suture technique without pledgets is an independent significant risk factor for major PVL events. In this study, use of pledgets during valve replacement had a protective effect against subsequent paravalvular leak, supporting the use of buttress reinforcement for valve suture. The use of Silzone cuff, although not statistically significant, showed a strong trend as a risk factor.

Aged↗
PubMed2004

Influence of valve prosthesis type on the recovery of ventricular dysfunction and subendocardial ischaemia following valve replacement for aortic stenosis.

BACKGROUND: Long-standing aortic stenosis (AS) causes significant progressive left ventricular (LV) dysfunction and may result in subendocardial ischaemia. Following aortic valve surgery, LV function may improve and this may be accompanied by reversal of ischaemia. There is debate about the differential effects of valve substitutes. METHODS: We studied 33 patients with significant AS and impaired LV systolic function. Patients underwent trans-thoracic Doppler echocardiography and 12-lead electrocardiography pre-operatively, prior to discharge from hospital and at 2.5 (range 1.5-3) years follow-up. RESULTS: Twenty patients received a stentless valve and 13 a stented valve. No patient had significant aortic regurgitation, other valvular disease or coronary artery disease. LV fractional shortening (FS) increased from 19+/-6% to 26+/-7% post-operatively and to 33+/-12% at follow-up in the stentless group (p<0.001). In the stented group, no significant change was seen in the post-operative FS, although it improved at follow-up and at this point did not differ from the stentless group. LV mass fell from 338+/-72 to 265+/-64 g post-operatively and to 170+/-77 g at follow-up (p<0.001) in the stentless group, whereas in the stented group a significant fall was seen only at follow-up (329+/-51 g pre-operatively, 304+/-68 g post-operatively, 166+/-28 g at follow-up, p=0.01). LV free wall excursion increased from 0.8+/-0.3 to 1.1+/-0.4 cm (p=0.05) and to 1.4+/-0.3 cm (p=0.02 compared with pre-operative values) in the stentless group. In the stented group, values were 1.0+/-0.4, 1.0+/-0.3 and 1.3+/-0.2 cm (p=0.05 compared with pre-operative) at the three time points, respectively. QRS duration fell from 113+/-36 ms pre-operatively to 99+/-12 ms at follow-up in the stentless group and from 117+/-28 to 99+/-19 ms in the stented group, p=0.01 for both comparisons. QT interval fell from 385+/-54 ms pre-operatively to 366+/-39 ms at follow-up (p=0.04) in the stentless group with no significant change in the stented group (387+/-52 and 375+/-33 ms, p=0.24). There was reversal of LV strain pattern in 11 (55%) of the stentless group and 6 (46%) of the stented group and normalisation of the inverted U wave in two thirds of patients. CONCLUSION: In patients with AS and severe LV dysfunction, there is a more rapid improvement in LV function following aortic valve replacement with a stentless prosthesis. Improvements in those receiving stented valves appear delayed, although there were no differences between the groups in LV function or mass at follow-up. Normalisation of LV free wall systolic behaviour, narrowing of the QRS complex and a reduction in the QT interval suggest that AS is associated with subendocardial ischaemia that reverses following valve replacement.

Aortic Valve↗
PubMed2002

Up to 8-year follow-up of valve replacement with carbomedics valve.

BACKGROUND: The aim of this study was to report midterm valve replacement (VR) results with the Carbo-Medics valve (Sulzer Carbomedics, Austin, TX). METHODS: From 1991 to 1999, 468 patients aged 13 to 76 years (mean 56 years) underwent VR with CarboMedics valve: 239 aortic (A), 167 mitral (M), and 62 A+M or double valve replacement (DVR). Mean follow-up time was 4.4 years; follow-up was 99.1% complete for 2,016 patient-years (PY). The anticoagulation level was targeted to an international normalized ratio of 1.47 to 2.8. RESULTS: The hospital mortality rate was 1.2%. Actuarial analysis for the entire group at 7 years for survival was 87%+/-2.3%. Freedom from valve-related death was 94%+/-1.9%. Freedom from thromboembolic and bleeding events, respectively, were as follows: for AVR, 82%+/-4.9% (2.4%/PY) and 88%+/-2.9% (1.6%/PY); for MVR, 95%+/-2.1% (0.8%/PY) and 91%+/-3.1% (1.3%/PY); and for DVR, 96%+/-3.2% (0.7%/PY) and 85%+/-9.7% (1.0%/PY). Actuarial freedom from reoperation was 98%+/-1.4%. CONCLUSIONS: The CarboMedics valve can be implanted with satisfactory early mortality and a low incidence of valve-related events even under low-intensity anticoagulation, as shown in a Japanese population.

Adolescent↗
PubMed1980

Patch enlargement of the aortic and the mitral valve rings with aortic-mitral double-valve replacement.

In 1 patient, patch enlargement of the aortic valve ring was accomplished by extending the aortic incision into the anterior mitral leaflet. The pericardial patch broke from the aortic leaflet of the mitral valve on the fourth postoperative day. The resultant acute mitral incompetence necessitated mitral valve replacement also. An aortic-mitral double-valve replacement with attendent enlargement of both the aortic and mitral valve rings ensued. To our knowledge, enlargement of the aortic and mitral valve rings with aortic-mitral double-valve replacement has not been described in the literature.

Aortic Valve↗
PubMed2000

Disruption of the silver and non-silver coated sewing cuff of a new generation bileaflet valve prosthesis during aortic valve replacement: report on four cases.

OBJECTIVES: New generation bileaflet valve prostheses with a silver-coated sewing cuff like the St Jude Medical (SJM((R)) Regent) model are designed to offer a larger valvular orifice as well as a better resistance to postoperative prosthetic endocarditis, at the expense of a smaller sewing cuff. METHODS AND RESULTS: We report on four cases of aortic valve replacement where during the implantation procedure the fixation cuff disrupted, leading to the exchange of all four valve prostheses. This happened three times with silver- coated sewing cuffs and after withdrawal of the silver- coated cuff prostheses from the market, once with a non silver- coated sewing cuff. This was due to the arbitrary cutting of the cuff fixation suture at the ventricular side of the prosthesis, although the implantation was performed according to the recommendations of the company. This problem didn't occur previously, using other models of the same manufacturer, although the sewing cuff had been fixed in the same technique. CONCLUSION: Fixation of smaller sewing cuffs of mechanical valve prostheses with a critically exposed fixation suture at the ventricular side of the prosthesis represents a significant risk for disruption during the implantation process through cut off by chance. We recommend meticulous inspection of the sewing cuff for signs of disruption before seating the valve into position. During follow-up particular attention should be paid to valve dislodgement and leakage. The company was informed and advised by us to modify the fixation of the prosthetic annulus of the SJM((R)) Regent valve, which has led to an alternative cuff design, called the SJM Flex cuff.

Aortic Valve↗
PubMed2000

Five-year follow-up of valve replacement with the Jyros bileaflet mechanical valve.

Jyros bileaflet rotating valves were implanted as a clinical trial conducted in Japan, and the 5-year results were assessed. Nineteen patients underwent implantation of the valves: 14 in the mitral and 5 in the aortic position. The mean follow-up period was 65.4+/-15.7 months. There was 1 case of late death due to fatal arrhythmia and another case of cerebral thromboembolism (1.0% per patient year). All survivors were in New York Heart Association class I. On the early postoperative cinefluorography, 8 valves (42.1%) showed rotation of the leaflets. However, in the latest assessment 6 valves (33.3%) showed rotation, some valves had stopped rotation, and others had started to rotate during the follow-up period. The Jyros valve functions effectively, similar to other bileaflet valves. However, because the correlation between thromboembolism and the rotation mechanism is not clear, further follow-up of our patients and more implant studies are necessary to elucidate this issue.

Adult↗
PubMed1999

Prosthetic valve endocarditis leading to valve replacement: a case study.

Infective endocarditis (IE) is a pathologic condition of native or prosthetic heart valves or endocardium, which may result in valve destruction and congestive heart failure. It occurs more frequently in men than in women, and there is an increased trend in the elderly. The following conditions predispose patients to IE: congenital and rheumatic heart disease, calcification or stenosis of a valve, prosthetic valve surgery, a previous episode of endocarditis, poor dentition, parenteral drug abuse, and placement of intravascular lines or devices. Effective treatment frequently involves a combination of intense antibiotic therapy and surgical repair. Risk of death from IE is related to age over 60, diagnosis of staphylococcal infection, involvement of an aortic or prosthetic valve, and the presence of any of the following sequelae of endocarditis: congestive heart failure, embolic phenomenon, and neurologic deficit. Clinicians should suspect endocarditis in patients presenting with fever of unknown origin and who are at risk for endocarditis. Timely evaluation with transthoracic or transesophageal echocardiography may identify patients in the early stages of endocarditis and direct the patient to definitive therapy. Early treatment of native and prosthetic valve endocarditis may decrease its overall morbidity and mortality. This case study illustrates some of the challenges in effectively managing prosthetic valve endocarditis.

Aged↗
PubMed1996

Thirty years experience with heart valve surgery: isolated aortic valve replacement.

BACKGROUND: Thirty years have elapsed since the commencement of open-heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic aortic valve replacement during this period. METHODS: Questionnaires and personal contact have been used to generate a combined database of pre-operative and post-operative information and long-term follow-up on 1322 patients who underwent isolated prosthetic aortic valve replacement at the Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1992. RESULTS: Complete survival follow-up data were obtained for 94% (1241) of the patients. The Bjork-Shiley valve was used in 66% (875) of the patients, a Starr-Edwards prosthesis in 31% (412), a St Jude prosthesis in 2% (26), and only 0.7% (9) bioprosthetic valves were inserted. The hospital mortality rate for the 30-year period was 2.9%. Progressively older and less fit patients have undergone surgery in recent years. The long-term survival of patients with aortic stenosis and aortic incompetence was not significantly different. Long-term survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications, and for patients in pre-operative atrial fibrillation. Pre-operative dyspnoea was significantly improved following aortic valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series. CONCLUSIONS: Aortic valve replacement can be performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable prognostic outcome compared with an age- and sex-matched population, and risk factors that determine long-term survival can be identified pre-operatively.

Adolescent↗
PubMed2006

[Inoperable valve disease: should percutaneous valve replacement be an option?].

Surgical valve replacement is the treatment of choice in patients with severe valvular heart disease. However, published data clearly show that long-term survival is seriously compromised in those with a low inotropic reserve. In addition, a growing number of patients (estimated to be around 15% of those with aortic stenosis) present in such a poor and deteriorating clinical condition that they cannot be accepted for surgery because it involves a very high risk of death. Percutaneous balloon valvuloplasty is a less aggressive alternative which offers a form of palliative treatment that can increase the patient's life expectancy and bring about immediate hemodynamic and clinical improvement. It is in this context that the possibility of carrying out percutaneous valve replacement has become available as a novel therapeutic option since Cribier first reported using the procedure to treat a patient with severe aortic stenosis. Since this first operation, both the techniques employed and the material composition of the prosthesis have undergone substantial development. However, significant problems have been encountered in evaluating the safety and efficacy of percutaneous valve replacement. These, to a great extent, stem from the risks associated with treating elderly patients who have high morbidity and mortality. In the United States, one clinical study was even suspended because two of the first four patients undergoing treatment died. In contrast, studies carried out in other countries, although they have involved only a few patients, have produced more promising results. Moreover, because the cause of death in these series was frequently due to factors that were independent of good valvular function, the future of the technique is generally thought to be positive. Nevertheless, the results obtained with percutaneous mitral valve replacement have been poor. In conclusion, the technique of percutaneous valve replacement, although still undergoing development, is becoming established as a viable alternative for treating inoperable valve disease, at least in aortic valves.

Aortic Valve Stenosis↗
PubMed1999

Valve replacement for aortic stenosis in patients with poor left ventricular function: comparison of early changes with stented and stentless valves.

BACKGROUND: Long-standing aortic stenosis causes significant left ventricular (LV) dysfunction, which may progress irreversibly. In many cases, LV function can be salvaged by aortic valve surgery, although debate exists regarding the best valve prosthesis to use. METHODS AND RESULTS: We studied 33 patients retrospectively who had significant aortic stenosis and impaired LV systolic function, as assessed by transthoracic Doppler echocardiography. Patients were assessed preoperatively and before discharge from the hospital. A total of 20 patients received a stentless (homograft or Toronto) valve, and 13, a stented valve. No patient had significant aortic regurgitation or other valvular disease. Preoperatively, fractional shortening was 18.8+/-5.5% in the stentless group and 18.6+/-3.8% in the stented group. Postoperatively, it was 25.6+/-6.9% (P<0.001 compared with baseline) and 17.0+/-2.8%, respectively (P<0.001 compared with stentless group). Fractional shortening improved because of a reduction in LV end-systolic and end-diastolic dimensions in the stentless group. Systolic long axis function at the LV free wall also recovered, with an increase in systolic excursion and both peak shortening and lengthening rates. No change was noted in mitral valve Doppler patterns. CONCLUSIONS: Patients who received a stentless valve demonstrated a significantly greater early improvement in LV systolic function compared with those who received a stented valve.

Aged↗
PubMed2004

Tricuspid valve replacement: bioprosthetic or mechanical valve?

Significant morbidity and mortality is associated with tricuspid valve replacement, and controversy still exists as to the ideal prosthesis in this position. This study aimed to identify the risk factors for low cardiac output and mortality, and whether bioprosthetic or mechanical valves perform better in the tricuspid position. Results of 121 tricuspid valve replacements in 104 patients between January 1966 and December 2002 were reviewed. Most patients were in New York Heart Association functional class III or IV. Perioperative mortality was 19%. On multivariate analysis, age and preoperative jaundice were significant predictors of low cardiac output; age, jaundice, atrial fibrillation, and bypass time were significant predictors of mortality. Mechanical valves were significantly more prone to thromboembolism, whereas bioprostheses suffered structural valve deterioration. There were no significant differences in anticoagulation or bleeding episodes between the two groups, nor in valve-related events, deaths, and long term survival. There was no significant difference in performance so as to recommend one type over the other, but bioprosthetic valves may be more favorable as they fail predictably.

Adolescent↗
PubMed1981

Easy method for measurement of opening angle of Björk-Shiley valve with two computers. Proof of floating phenomenon of Björk-Shiley valve.

A new method for measuring the opening angle of Björk-Shiley valve (B-S valve) was reported in 1977. However, this method is complicated enough to permit quick calculation of the opening angle in multiple frames of one cinefilm. We devised a new method with using two computers (NAC Cardias GP 2000, TEXAS TI-59) for calculating the opening angle of the B-S valve. We measured the opening angle of 7 cases (they were all implanted B-S valves, 5 were mitral and 2 were aortic). Results are the following: (1) The maximum opening angle ranged from 54 degrees to 65 degrees and the mean value was 58.1 degrees. (2) We showed the floating phenomenon of B-S valve with our method. (3) We showed the accuracy of our method by measuring 10 times the same photograph of B-S valve. (4) We showed that our method is very accurate by comparing the values calculated by our method with those calculated directly from the valve which was removed from a patient. (5) It takes less than 30 minutes to calculate the opening angle of 60 frames (we took 60 frames of cine-film per minutes.

Aortic Valve↗
PubMed1976

Mitral valve replacement with ball and tilting disc valve prosthesis. A clinical and haemodynamic study.

A survey is presented on the results of 100 consecutive patients who underwent mitral valve (78 patients) or mitral and aortic and/or tricuspid valve replacement (22 patients) with ball or disc valve prosthesis. The patients were followed-up from 6 to 54 months postoperatively. The mortality for mitral valve replacement was 13 (17%) early deaths (up to one month from operation) and 5 (6%) late deaths. The corresponding figures for multiple valve replacements were 9 (41%) and 3 (14%). A direct correlation was found between early mortality and preoperative functional class IV of the New York Heart Association (30% dead). Pulmonary hypertension combined with multiple valve disease resulted in an early mortality of 42%. No significant differences in early mortality figures after MVR were found between ball and disc valve prostheses. Predominant complications were respiratory infection and atelectasis (13%), acute myocardial infarction (11%) and haemorrhage (9%). Haemolysis was found in 9 patients and three other patients had haemolytic anaemia attributable to paravalvular leak which in two indicated the reapplication of the prosthesis. The main causes of death were heart failure, 8 early and 4 late deaths, and myocardial infarction, 5 and 4 respectively.

Adolescent↗
PubMed2001

Differences in heart valve procedures between North American and European centers: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT).

BACKGROUND AND AIM OF THE STUDY: Differences in heart valve procedures between North American (NA) and European (EU) centers were evaluated in a multicenter trial. METHODS: Between July 1998 and January 2000, 807 patients from 12 NA (n = 446) and seven EU centers (n = 361) were randomized to receive either Silzone or conventional valves in the Artificial Valve Endocarditis Reduction Trial (AVERT). Subanalysis was performed to compare demographics, patient risk profile, surgical techniques and perioperative management of patients in NA and EU centers. RESULTS: Mean age was significantly younger and body mass index higher in NA. Patients' risk profiles showed significantly higher incidences of previous myocardial infarction, congestive heart failure, angina, prior cardiovascular surgery, and history of smoking in NA. A different distribution of implant position was observed between groups: aortic valve/mitral valve/double valve replacement in 54.0, 35.7 and 10.3% in NA, and 64.5, 27.4 and 8.0% in EU (p <0.01). Concomitant coronary artery bypass grafting was performed in 31.6% of NA patients and 19.4% of EU patients (p <0.001). Timing of surgery showed a higher incidence of urgent procedures in NA centers. Distribution of valve sizes and perioperative complication rate were similar, but length of hospital stay was longer in EU centers. CONCLUSION: Surprisingly, surgeons in NA and EU centers are faced by different patient populations requiring mechanical heart valve replacement. NA patients were younger, but required more extensive surgery. Surgical technique and perioperative management appear to differ in NA and EU centers. These differences in reporting heart valve procedures might have been influenced by variable interpretations of definitions and different patient expectations, although a uniform study protocol with consistent definitions was used at all sites.

Aged↗
PubMed2001

Mechanisms of mechanical heart valve cavitation: investigation using a tilting disk valve model.

BACKGROUND AND AIM OF THE STUDY: The induction of mechanical heart valve (MHV) cavitation was investigated using a 27 mm Medtronic Hall (MH27) tilting disk valve. METHODS: The MH27 valve was mounted in the mitral position of a simulating pulse flow system, and stroboscopic lighting used to visualize cavitation bubbles on the occluder inflow surface at the instant of valve closure. MHV cavitation was monitored using a digital camera with 0.04 mm/pixel resolution sufficient to render the tiny bubbles clearly visible on the computer monitor screen. RESULTS: Cavitation on MH27 valve was classified as five types according to the time, site and shape of the cavitation bubbles. Valve cavitation occurred at the instant of occluder impact with the valve seat at closing. The impact motion was subdivided into three temporal phases: (i) squeezing flow; (ii) elastic collision; and (iii) leaflet rebound. MHV cavitation caused by vortices was found to be initiated by the squeezing jet and/or by the transvalvular leakage jets. By using a tension wave which swept across the occluder surface immediately upon elastic impact, nuclei in the vortex core were expanded to form cavitation bubbles. CONCLUSION: Analysis of the shape and location of the cavitation bubbles permitted a better understanding of MHV cavitation mechanisms, based on the fluid dynamics of jet vortex and tension wave propagations.

Biomechanical Phenomena↗
PubMed2002

The pulmonary bioprosthetic heart valve: its unsuitability for use as an aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: The porcine pulmonary bioprosthetic heart valve represents an alternative means of aortic valve replacement (AVR), though knowledge of its biomechanical function and characteristics is limited. The valve has potential advantages over the aortic bioprosthesis; notably, it lacks the muscular shelf of the right coronary cusp of the latter bioprosthesis. The study aim was to investigate the suitability of the porcine pulmonary bioprosthetic valve for AVR. METHODS: Porcine pulmonary and aortic roots were zero pressure-fixed with 0.5% buffered glutaraldehyde, characterized, and compared with fresh porcine pulmonary and aortic roots. The in-vitro analysis included assessment of mechanical properties, hydrodynamic function, geometry of the pulmonary root, and durability. RESULTS: The fixed pulmonary roots and fresh aortic roots were similar in certain aspects of mechanical response, notably leaflets in the radial direction and the root wall. The fixed pulmonary root was slightly more compliant than the fixed aortic root, and this led to an improvement in forward flow hydrodynamic function. The reverse flow hydrodynamic function of the pulmonary roots was poor; fresh pulmonary roots exhibited a trivial closed valve regurgitant volume. On fixation, this characteristic was aggravated, leading to a gross closed valve regurgitant volume in 50% of all fixed pulmonary roots. The cause of leakage was identified as a prolapsed anterior leaflet. Durability of the fixed pulmonary root was also inferior to that of the fixed aortic root; three fixed pulmonary roots subjected to accelerated fatigue testing showed signs of leaflet macroscopic damage. CONCLUSION: Overall, the performance of the porcine pulmonary bioprosthesis was far inferior to that of the currently used porcine aortic bioprosthesis. Hence, the porcine pulmonary bioprosthetic valve was deemed unsuitable for AVR.

Animals↗
PubMed2005

Valve-sparing root replacement after prior Starr-Edwards aortic valve replacement.

Historically, patients with prior aortic valve replacements who subsequently present with an ascending aortic aneurysm require placement of a valve conduit. However, if the patient has a functional mechanical valve with proven long-term durability, an attempt can be made to preserve the intact valve and to graft the aneurysmal aortic root. The case is described of a patient with a previously placed Starr-Edwards aortic valve who subsequently developed a 6-cm ascending aortic aneurysm. By removing the valve ball and using the existing sewing ring, a proximal graft anastomosis was created with ease, eliminating valve excision.

Aged↗
PubMed2006

Preoperative cholesterol levels do not predict explant for structural valve deterioration in patients undergoing bioprosthetic aortic valve replacement.

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.

Aged↗