|
1
|
Montero JA, Venturino F, Cubas S, Rodríguez S, Hernández M, Sosa C, Rodríguez M, Brusich D, Dayan V. Comparative evaluation of mechanical and biological prostheses in patients with aortic stenosis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2025; 40:ivaf091. [PMID: 40209078 PMCID: PMC12055754 DOI: 10.1093/icvts/ivaf091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 04/08/2025] [Indexed: 04/12/2025]
Abstract
OBJECTIVES The commonly accepted aortic valve prostheses have been either mechanical or biological. Each type has its advantages and disadvantages, with age being the most widely accepted variable to determine the best option. There is, however, a range between 60 and 70 years where an individualized approach is required. METHODS This is a retrospective study. The primary outcome was overall survival based on the type of prosthesis used, stratified by effect modifiers. Association between prosthesis type and mortality rate was evaluated using the incidence rate ratio. Secondary outcomes included cardiovascular survival, postoperative mortality and complications, adjusted for age. Cox regression analysis was performed to account for confounders. Variation in the hazard ratio for death by age was explored by fitting a restricted cubic spline to the interaction between age and valve type. We included all adult patients who underwent surgical aortic valve replacement for severe stenosis in Uruguay from 2011 to 2021. A total of 3944 patients were enrolled; 1708 were females. Median follow-up time was 4.5 years. RESULTS Bioprostheses (BP) were associated with higher mortality in males and in patients without statins. When mortality rate was stratified by age, BP were associated with a higher risk in patients younger than 60 and a lower risk in the 70-79 age group. CONCLUSIONS BP are associated with worse survival in male patients and in the <60-year-old age group. Gender and statins should be considered when deciding the prosthesis for patients in the 60-69 age group. When the relative survival benefit of BP was analysed, 70 years was identified as the threshold at which their benefit became evident compared to mechanical prostheses.
Collapse
Affiliation(s)
- Juan Andres Montero
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Federica Venturino
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Santiago Cubas
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Sofía Rodríguez
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Maximiliano Hernández
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Carolina Sosa
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Maximiliano Rodríguez
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Daniel Brusich
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Victor Dayan
- Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| |
Collapse
|
|
2
|
Dayan V, Montero JA, Freemantle N. Medium-term survival of patients with mechanical and biological aortic prosthesis at the 6th decade of life. PLoS One 2024; 19:e0312408. [PMID: 39556548 PMCID: PMC11573135 DOI: 10.1371/journal.pone.0312408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 10/04/2024] [Indexed: 11/20/2024] Open
Abstract
OBJECTIVE The best aortic prosthesis type in 60-70 year old patients is not established. Our aim was to evaluate the survival in a National cohort of patients between 60-70 years old who required surgical aortic valve replacement for aortic stenosis (SAVR) with either a mechanical (MP) or bioprosthesis (BP) valve. METHODS This is a retrospective study using national data from the Ministry of Health. We included all patients between 60 to 70 years old who underwent SAVR for aortic stenosis in Uruguay from 2011 to 2021. The primary outcome was overall survival according to type of prosthesis used stratified by effect modifiers. The independent effects of gender and use of statins were evaluated. RESULTS We included 1196 patients (66±3.0 years old; 39.1% female). Mortality was higher for BP (296, 29.9%%) than MP (36, 17.1%; p<0.001). Median follow-up time was 4.5 years (Interquartile range [IQR] 3.4-6.5). The unadjusted incidence rate ratio was higher for BP (Incidence rate ratio [IRR] = 1.43;95%CI: 0.99, 2.14, p = 0.045). The effect of BP on mortality rate was greater in males (IRR = 1.82;95%CI:1.14,2.92. p interaction = 0.08) and patients who were not taking statins (IRR = 1.97;95%CI:1.14,3.41. p interaction = 0.06). The use of BP was an independent predictor of overall survival in male patients (Hazard ratio [HR] = 1.32;95%CI: 1.68, 1.04. p = 0.021) and in patients who were not taking statins (HR = 2.07;95%CI: 1.17, 3.67. p = 0.013). CONCLUSION The use of BP was associated with worse survival in male patients and patients not taking statins. Gender and statins use should contribute to type of prosthesis decision in the 60-69 age group.
Collapse
Affiliation(s)
- Victor Dayan
- Centro Cardiovascular Universitario, Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay
| | - Juan Andres Montero
- Centro Cardiovascular Universitario, Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| |
Collapse
|
|
3
|
Chong T, Lan NSR, Courtney W, He A, Strange G, Playford D, Dwivedi G, Hillis GS, Ihdayhid AR. Medical Therapy to Prevent or Slow Progression of Aortic Stenosis: Current Evidence and Future Directions. Cardiol Rev 2024; 32:473-482. [PMID: 36961371 DOI: 10.1097/crd.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Degenerative aortic stenosis is a growing clinical problem owing to the high incidence in an aging population and its significant morbidity and mortality. Currently, aortic valve replacement remains the only treatment. Despite promising observational data, pharmacological management to slow or halt progression of aortic stenosis has remained elusive. Nevertheless, with a greater understanding of the mechanisms which underpin aortic stenosis, research has begun to explore novel treatment strategies. This review will explore the historical agents used to manage aortic stenosis and the emerging agents that are currently under investigation.
Collapse
Affiliation(s)
- Travis Chong
- From the Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
| | - Nick S R Lan
- From the Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
- Internal Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - William Courtney
- Internal Medicine, Medical School, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Albert He
- From the Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
| | - Geoff Strange
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Girish Dwivedi
- From the Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
- Internal Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Graham S Hillis
- Internal Medicine, Medical School, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Abdul Rahman Ihdayhid
- From the Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
| |
Collapse
|
|
4
|
Li Z, Zhang B, Salaun E, Côté N, Mahjoub H, Mathieu P, Dahou A, Zenses AS, Xu Y, Pibarot P, Wu Y, Clavel MA. Association between remnant cholesterol and progression of bioprosthetic valve degeneration. Eur Heart J Cardiovasc Imaging 2023; 24:1690-1699. [PMID: 37409985 PMCID: PMC10667036 DOI: 10.1093/ehjci/jead159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 07/02/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS Remnant cholesterol (RC) seems associated with native aortic stenosis. Bioprosthetic valve degeneration may share similar lipid-mediated pathways with aortic stenosis. We aimed to investigate the association of RC with the progression of bioprosthetic aortic valve degeneration and ensuing clinical outcomes. METHODS AND RESULTS We enrolled 203 patients with a median of 7.0 years (interquartile range: 5.1-9.2) after surgical aortic valve replacement. RC concentration was dichotomized by the top RC tertile (23.7 mg/dL). At 3-year follow-up, 121 patients underwent follow-up visit for the assessment of annualized change in aortic valve calcium density (AVCd). RC levels showed a curvilinear relationship with an annualized progression rate of AVCd, with increased progression rates when RC >23.7 mg/dL (P = 0.008). There were 99 deaths and 46 aortic valve re-interventions in 133 patients during a median clinical follow-up of 8.8 (8.7-9.6) years. RC >23.7 mg/dL was independently associated with mortality or re-intervention (hazard ratio: 1.98; 95% confidence interval: 1.31-2.99; P = 0.001). CONCLUSION Elevated RC is independently associated with faster progression of bioprosthetic valve degeneration and increased risk of all-cause mortality or aortic valve re-intervention.
Collapse
Affiliation(s)
- Ziang Li
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, People’s Republic of China
| | - Bin Zhang
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, People’s Republic of China
| | - Erwan Salaun
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Nancy Côté
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Haifa Mahjoub
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Patrick Mathieu
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Abdelaziz Dahou
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Anne-Sophie Zenses
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Yujun Xu
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health LMU Munich, Munich, Germany
| | - Philippe Pibarot
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Yongjian Wu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, People’s Republic of China
| | - Marie-Annick Clavel
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| |
Collapse
|
|
5
|
Wen S, Zhou Y, Yim WY, Wang S, Xu L, Shi J, Qiao W, Dong N. Mechanisms and Drug Therapies of Bioprosthetic Heart Valve Calcification. Front Pharmacol 2022; 13:909801. [PMID: 35721165 PMCID: PMC9204043 DOI: 10.3389/fphar.2022.909801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Valve replacement is the main therapy for valvular heart disease, in which a diseased valve is replaced by mechanical heart valve (MHV) or bioprosthetic heart valve (BHV). Since the 2000s, BHV surpassed MHV as the leading option of prosthetic valve substitute because of its excellent hemocompatible and hemodynamic properties. However, BHV is apt to structural valve degeneration (SVD), resulting in limited durability. Calcification is the most frequent presentation and the core pathophysiological process of SVD. Understanding the basic mechanisms of BHV calcification is an essential prerequisite to address the limited-durability issues. In this narrative review, we provide a comprehensive summary about the mechanisms of BHV calcification on 1) composition and site of calcifications; 2) material-associated mechanisms; 3) host-associated mechanisms, including immune response and foreign body reaction, oxidative stress, metabolic disorder, and thrombosis. Strategies that target these mechanisms may be explored for novel drug therapy to prevent or delay BHV calcification.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Weihua Qiao
- *Correspondence: Weihua Qiao, ; Nianguo Dong,
| | | |
Collapse
|
|
6
|
Comparison of long-term mortality in patients who underwent transcatheter aortic valve replacement with or without anti-atherosclerotic therapy. Heart Vessels 2021; 36:1892-1902. [PMID: 34101028 DOI: 10.1007/s00380-021-01873-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Atherosclerosis is a risk factor for both aortic stenosis (AS) and coronary artery disease. This study aimed to investigate whether anti-atherosclerotic therapy (AT), defined as the simultaneous use of antiplatelet agents, statins, and renin aldosterone system inhibitors, had long-term clinical benefits for patients who underwent transcatheter aortic valve replacement (TAVR). Between October 2013 and May 2017, 2518 patients (31% men; median age, 85 years) who underwent TAVR in 14 Japanese centers were divided into two groups: patients who were prescribed anti-atherosclerotic therapy (AT, n = 567) and patients who were not (no AT, n = 1951). The median follow-up period for this cohort was 693 days (interquartile range, 389-870 days). Compared to no AT group, AT group was associated with significantly lower 2-year all-cause mortality (11.7% vs. 16.5%; log-rank p = 0.002) and 2-year cardiovascular mortality rates (3.5% vs. 6.0%; log-rank p = 0.017). In a propensity-matched cohort (n = 495 each; median follow-up, 710 days [IQR, 394 - 896 days]), patients in AT group had a lower prevalence of 2-year cardiovascular mortality (3.8% vs. 6.2%, log-rank p = 0.024) than that in the no AT group. In the multivariate stepwise regression analysis, AT was a significant predictor of cardiovascular mortality (hazard ratio 0.45; 95% confidence interval 0.25-0.80; p = 0.007). AT may improve survival in post-TAVR patients. Future studies are necessary to identify an optimal treatment regimen to improve long-term outcomes after TAVR.
Collapse
|
|
7
|
Kostyunin AE, Yuzhalin AE, Rezvova MA, Ovcharenko EA, Glushkova TV, Kutikhin AG. Degeneration of Bioprosthetic Heart Valves: Update 2020. J Am Heart Assoc 2020; 9:e018506. [PMID: 32954917 PMCID: PMC7792365 DOI: 10.1161/jaha.120.018506] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long‐term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.
Collapse
Affiliation(s)
- Alexander E Kostyunin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Arseniy E Yuzhalin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation.,Department of Molecular and Cellular Oncology The University of Texas MD Anderson Cancer Center Houston TX
| | - Maria A Rezvova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Evgeniy A Ovcharenko
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Tatiana V Glushkova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Anton G Kutikhin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| |
Collapse
|
|
8
|
Frasca A, Xue Y, Kossar AP, Keeney S, Rock C, Zakharchenko A, Streeter M, Gorman RC, Grau JB, George I, Bavaria JE, Krieger A, Spiegel DA, Levy RJ, Ferrari G. Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves. JACC Basic Transl Sci 2020; 5:755-766. [PMID: 32875167 PMCID: PMC7452200 DOI: 10.1016/j.jacbts.2020.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
Two novel and interacting mechanisms contributing to BHV SVD are reported: glycation and serum albumin infiltration. Glycation product formation and serum albumin deposition were observed in 45 clinical BHV explanted due to SVD as well as BHV tissue subcutaneously implanted in rats. In vitro exposure to glycation and serum albumin elicited collagen network misalignment similar to that seen in clinical and rat explant BHV tissue. Glycation was sufficient to impair BHV hydrodynamic function in ISO-5840-compliant pulse duplication testing and concomitant serum albumin infiltration exacerbated these effects. Valvular heart diseases are associated with significant cardiovascular morbidity and mortality, and often require surgical and/or percutaneous repair or replacement. Valve replacement is limited to mechanical and biological prostheses, the latter of which circumvent the need for lifelong anticoagulation but are subject to structural valve degeneration (SVD) and failure. Although calcification is heavily studied, noncalcific SVD, which represent roughly 30% of BHV failures, is relatively underinvestigated. This original work establishes 2 novel and interacting mechanisms—glycation and serum albumin incorporation—that occur in clinical valves and are sufficient to induce hallmarks of structural degeneration as well as functional deterioration.
Collapse
Key Words
- AGE, advanced glycation end product
- BHV, bioprosthetic heart valve
- BP, bovine pericardium
- CML, N-carboxymethyl-lysine
- EOA, effective orifice area
- HSA, human serum albumin
- IHC, immunohistochemistry
- PBS, phosphate-buffered saline
- SAVR, surgical aortic valve replacement
- SHG, second harmonic generation
- SVD, structural valve degeneration
- TAVR, transcatheter aortic valve replacement
- advanced glycation end products
- aortic valve disease
- biomaterial
- bioprosthetic heart valve
Collapse
Affiliation(s)
- Antonio Frasca
- Department of Surgery, Columbia University, New York, New York
| | - Yingfei Xue
- Department of Surgery, Columbia University, New York, New York
| | | | - Samuel Keeney
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher Rock
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrey Zakharchenko
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew Streeter
- Department of Chemistry, Yale University, New Haven, Connecticut
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan B Grau
- Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Isaac George
- Department of Surgery, Columbia University, New York, New York
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abba Krieger
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, Connecticut
| | - Robert J Levy
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | |
Collapse
|
|
9
|
Ramana R, Morreale C, Kothari S, Moura LM, Best P, Burke M, Rajamannan NM. Calcification and Thrombosis as Mediators of Bioprosthetic Valve Deterioration. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2018.1562265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
|
10
|
Salaun E, Mahjoub H, Girerd N, Dagenais F, Voisine P, Mohammadi S, Yanagawa B, Kalavrouziotis D, Juni P, Verma S, Puri R, Coté N, Rodés-Cabau J, Mathieu P, Clavel MA, Pibarot P. Rate, Timing, Correlates, and Outcomes of Hemodynamic Valve Deterioration After Bioprosthetic Surgical Aortic Valve Replacement. Circulation 2018; 138:971-985. [DOI: 10.1161/circulationaha.118.035150] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
- Centre de Résonance Magnétique Biologique et Médicale, Centre National de la Recherche Scientifique, Aix-Marseille Université, France (E.S.)
| | - Haïfa Mahjoub
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Nicolas Girerd
- INSERM, Centre d’Investigations Cliniques, Université de Lorraine, CHU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, France (N.G.)
| | - François Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Pierre Voisine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Siamak Mohammadi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael’s Hospital, Toronto, Ontario, Canada (B.Y., S.V.)
| | - Dimitri Kalavrouziotis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Peter Juni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Ontario, Canada (P.J.)
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael’s Hospital, Toronto, Ontario, Canada (B.Y., S.V.)
| | - Rishi Puri
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, OH (R.P.)
- Department of Medicine, University of Adelaide, South Australia, Australia (R.P.)
| | - Nancy Coté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Patrick Mathieu
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| |
Collapse
|
|
11
|
Son J, Cho YH, Jeong DS, Sung K, Kim WS, Lee YT, Park PW. Mechanical versus Tissue Aortic Prosthesis in Sexagenarians: Comparison of Hemodynamic and Clinical Outcomes. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:100-108. [PMID: 29662807 PMCID: PMC5894573 DOI: 10.5090/kjtcs.2018.51.2.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/02/2017] [Accepted: 11/13/2017] [Indexed: 01/20/2023]
Abstract
Background The question of which type of prosthetic aortic valve leads to the best outcomes in patients in their 60s remains controversial. We examined the hemodynamic and clinical outcomes of aortic valve replacement in sexagenarians according to the type of prosthesis. Methods We retrospectively reviewed 270 patients in their 60s who underwent first-time aortic valve replacement from 1995 to 2011. Early and late mortality, major adverse valve-related events, anticoagulation-related events, and hemodynamic outcomes were assessed. The mean follow-up duration was 58.7±44.0 months. Results Of the 270 patients, 93 had a mechanical prosthesis (mechanical group), and 177 had a bioprosthesis (tissue group). The tissue group had a higher mean age and prevalence of preoperative stroke than the mechanical group. The groups had no differences in the aortic valve mean pressure gradient (AVMPG) or the left ventricular mass index (LVMI) at 5 years after surgery. In a sub-analysis limited to prostheses in the supra-annular position, the AVMPG was higher in the tissue group, but the LVMI was still not significantly different. There was no early mortality. The 10-year survival rate was 83% in the mechanical group and 90% in the tissue group. The type of aortic prosthesis did not influence overall mortality, cardiac mortality, or major adverse valve-related events. Anticoagulation-related events were more common in the mechanical group than in the tissue group (p=0.034; hazard ratio, 4.100; 95% confidence interval, 1.111–15.132). Conclusion The type of aortic prosthesis was not associated with hemodynamic or clinical outcomes, except for anticoagulation-related events.
Collapse
Affiliation(s)
- Jongbae Son
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| |
Collapse
|
|
12
|
Akin I, Nienaber CA. Is there evidence for statins in the treatment of aortic valve stenosis? World J Cardiol 2017; 9:667-672. [PMID: 28932355 PMCID: PMC5583539 DOI: 10.4330/wjc.v9.i8.667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/21/2017] [Accepted: 06/06/2017] [Indexed: 02/06/2023] Open
Abstract
Research revealed that the pathogenesis of aortic stenosis (AS) not merely comprises of a mechanical wear and tear process yet that active biological processes, similar to those of coronary artery disease are involved, a promising role for statins in disease-modifying therapy was suggested. However, recently, many prospective studies could not observe decreased progression nor regression of the disease. Here, we review the current knowledge on the pathomechanisms of AS and its similarities and differences with atherosclerosis. Moreover, we discuss whether there is still a place for statins in the treatment of particular AS patient subgroups.
Collapse
Affiliation(s)
- Ibrahim Akin
- Medical Faculty Mannheim, University Heidelberg, 68167 Mannheim, Germany
| | | |
Collapse
|
|
13
|
Abstract
Untreated, severe, symptomatic aortic stenosis is associated with a dismal prognosis. The only treatment shown to improve survival is aortic valve replacement; however, before symptoms occur, aortic stenosis is preceded by a silent, latent phase characterized by a slow progression at the molecular, cellular, and tissue levels. In theory, specific medical therapy should halt aortic stenosis progression, reduce its hemodynamic repercussions on left ventricular function and remodeling, and improve clinical outcomes. In the present report, we performed a systematic review of studies focusing on the medical treatment of patients with aortic stenosis. Lipid-lowering therapy, antihypertensive drugs, and anticalcific therapy have been the main drug classes studied in this setting and are reviewed in depth. A critical appraisal of the preclinical and clinical evidence is provided, and future research avenues are presented.
Collapse
Affiliation(s)
- Guillaume Marquis-Gravel
- From Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada (G.M.-G., P.G.); Cardiovascular Research Foundation, New York, NY (B.R., M.B.L., P.G.); Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); Columbia University Medical Center, New York, NY (M.B.L., P.G.); and Morristown Medical Center, Morristown, NJ (P.G.)
| | - Björn Redfors
- From Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada (G.M.-G., P.G.); Cardiovascular Research Foundation, New York, NY (B.R., M.B.L., P.G.); Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); Columbia University Medical Center, New York, NY (M.B.L., P.G.); and Morristown Medical Center, Morristown, NJ (P.G.)
| | - Martin B Leon
- From Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada (G.M.-G., P.G.); Cardiovascular Research Foundation, New York, NY (B.R., M.B.L., P.G.); Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); Columbia University Medical Center, New York, NY (M.B.L., P.G.); and Morristown Medical Center, Morristown, NJ (P.G.)
| | - Philippe Généreux
- From Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada (G.M.-G., P.G.); Cardiovascular Research Foundation, New York, NY (B.R., M.B.L., P.G.); Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); Columbia University Medical Center, New York, NY (M.B.L., P.G.); and Morristown Medical Center, Morristown, NJ (P.G.).
| |
Collapse
|
|
14
|
Incidence, risk factors, clinical impact, and management of bioprosthesis structural valve degeneration. Curr Opin Cardiol 2017; 32:123-129. [DOI: 10.1097/hco.0000000000000372] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
|
15
|
Abstract
Objective: To review the evidence evaluating the efficacy of statins in reducing the progression of calcified aortic stenosis (AS). Data Sources: MEDLINE, EMBASE, and PubMed were searched (all up to November 2006) for studies evaluating the use of statins to reduce the progression of calcified AS. Search terms included statin, HMG CoA reductase inhibitor, calcified AS, valve stenosis, and calcified stenosis. Additional primary trials were located by searching references noted in review articles. Study Selection and Data Extraction: Clinical trials published in the English language were selected for review. Primary efficacy outcomes evaluated were changes in aortic valve measurements, hemodynamic measures of AS, and change in measures of AS severity. Data Synthesis: TWO prospective clinical trials and 5 retrospective studies were included in this review. All of the retrospective studies demonstrated that statin use was associated with a statistically significant delay in the progression of AS. One prospective observation trial showed benefit of statin use; however, a large, randomized, double-blind, prospective trial showed no benefit of statin use in decreasing the progression of AS. Conclusions: An association between statin use and a delay in AS progression has been observed in retrospective studies; however, prospective trials showed conflicting results. Currently, statins cannot be recommended for medical treatment of AS until larger trials are conducted.
Collapse
Affiliation(s)
- Doson Chua
- St. Paul's Hospital, Vancouver, BC, Canada.
| | | |
Collapse
|
|
16
|
Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999-3058. [PMID: 27567407 DOI: 10.1093/eurheartj/ehw272] [Citation(s) in RCA: 1973] [Impact Index Per Article: 219.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
|
17
|
Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Atherosclerosis 2016; 253:281-344. [DOI: 10.1016/j.atherosclerosis.2016.08.018] [Citation(s) in RCA: 562] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
|
18
|
Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement: Multicenter Registry. J Am Coll Cardiol 2016; 67:644-655. [PMID: 26868689 DOI: 10.1016/j.jacc.2015.10.097] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/21/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Scarce data exist on the incidence of and factors associated with valve hemodynamic deterioration (VHD) after transcatheter aortic valve replacement (TAVR). OBJECTIVES This study sought to determine the incidence, timing, and predictors of VHD in a large cohort of patients undergoing TAVR. METHODS This multicenter registry included 1,521 patients (48% male; 80 ± 7 years of age) who underwent TAVR. Mean echocardiographic follow-up was 20 ± 13 months (minimum: 6 months). Echocardiographic examinations were performed at discharge, at 6 to 12 months, and yearly thereafter. Annualized changes in mean gradient (mm Hg/year) were calculated by dividing the difference between the mean gradient at last follow-up and the gradient at discharge by the time between examinations. VHD was defined as a ≥10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessment. RESULTS The overall mean annualized rate of transprosthetic gradient progression during follow-up was 0.30 ± 4.99 mm Hg/year. A total of 68 patients met criteria of VHD (incidence: 4.5% during follow-up). The absence of anticoagulation therapy at hospital discharge (p = 0.002), a valve-in-valve (TAVR in a surgical valve) procedure (p = 0.032), the use of a 23-mm valve (p = 0.016), and a greater body mass index (p = 0.001) were independent predictors of VHD. CONCLUSIONS There was a mild but significant increase in transvalvular gradients over time after TAVR. The lack of anticoagulation therapy, a valve-in-valve procedure, a greater body mass index, and the use of a 23-mm transcatheter valve were associated with higher rates of VHD post-TAVR. Further prospective studies are required to determine whether a specific antithrombotic therapy post-TAVR may reduce the risk of VHD.
Collapse
|
|
19
|
Differing relationship between hypercholesterolemia and a bicuspid aortic valve according to the presence of aortic valve stenosis or aortic valve regurgitation. Gen Thorac Cardiovasc Surg 2015; 63:502-6. [PMID: 26033769 DOI: 10.1007/s11748-015-0561-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 05/16/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the difference in hyperlipidemia between patients with bicuspid aortic valve (BAV) and those with a normal aortic valve (NAV), and to compare aortic valve stenosis (AS), with aortic valve regurgitation (AR). METHODS Among 32 patients with BAV and 142 patients with NAV who underwent aortic valve replacement, 81 patients had AR and 91 patients had AS. The preoperative clinical characteristics were compared between the BAV and NAV patients. Patients with replacement of the ascending aorta were included, and those who underwent combined valvular surgery, coronary artery bypass grafting, or statin treatment were excluded. RESULTS The proportions of females patients (p = 0.42), patients with diabetes (p = 0.26) and patients on dialysis (p = 0.69) were similar in the two groups. Mean age was significantly lower, the mean diameter of the ascending aorta was significantly larger, and the rate of surgical intervention for the ascending aorta was significantly higher in the BAV group than in the NAV group (all p < 0.0001). The mean levels of low-density lipoprotein cholesterol (LDL) (p < 0.0001) and total cholesterol (TC) (p = 0.0003) were significantly higher in the BAV group than in the NAV group, in the analysis of only patients with AS, whereas these levels did not differ significantly between the groups, when only patients with AR were considered. CONCLUSION BAV with AS is associated with hypercholesterolemia. However, BAV with AR was not associated with hypercholesterolemia.
Collapse
|
|
20
|
Yap SC, Takkenberg JJM, Witsenburg M, Meijboom FJ, Roos-Hesselink JW. Aortic stenosis at young adult age. Expert Rev Cardiovasc Ther 2014; 3:1087-98. [PMID: 16292999 DOI: 10.1586/14779072.3.6.1087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic stenosis at young adult age is usually the result of a stenotic bicuspid aortic valve, which is the most common cardiac congenital anomaly. In clinical practice, exercise and pregnancy are important topics. Furthermore, the timing of intervention is under debate, as little information is available on the natural history and outcome after aortic valve replacement in these young adults. In older patients, there is a trend towards earlier intervention. With the increased knowledge of the pathophysiology of aortic stenosis, studies have focused on the dilatation of the ascending aorta with risk of dissection. Recently, it has been suggested that pharmacologic treatment of aortic stenosis could be beneficial for these young adults.
Collapse
Affiliation(s)
- Sing-Chien Yap
- Department of Cardiology, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
|
21
|
Skowasch D, Steinmetz M, Nickenig G, Bauriedel G. Is the degeneration of aortic valve bioprostheses similar to that of native aortic valves? Insights into valvular pathology. Expert Rev Med Devices 2014; 3:453-62. [PMID: 16866642 DOI: 10.1586/17434440.3.4.453] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic stenosis (AS) is the most common valvular disease requiring valve replacement with a prevalence of 2-4% in adults greater than or equal to 65 years of age. There is increasing evidence that AS is an active inflammatory process that is highly regulated, displaying multiple hallmarks of atherosclerosis. Clinically, the definite therapy of advanced AS is prosthetic valve replacement. Herein, bioprosthetic tissue valves (BPs) possess superior thromboresistant and hemodynamic properties compared with mechanical valves. However, cusp degeneration and calcification also limit their long-term outcome. The pathogenesis of BP calcification as well as that of native valves is still poorly understood. Recent studies suggest a similar valvular pathology, that underlies both types of valvular degeneration, but also an even more important role of inflammatory and repair processes in the case of BP degeneration.
Collapse
Affiliation(s)
- Dirk Skowasch
- University of Bonn, Department of Internal Medicine II/Cardiology, Sigmund Freud Str. 25, D-53105 Bonn, Germany.
| | | | | | | |
Collapse
|
|
22
|
Chacko J, Harling L, Ashrafian H, Athanasiou T. Can statins improve outcomes after isolated cardiac valve surgery? A systematic literature review. Clin Cardiol 2013; 36:448-55. [PMID: 23670956 DOI: 10.1002/clc.22140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 04/11/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND HMG CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors, or statins, have been associated with an improvement in outcomes after coronary artery surgery for some time; however, their role in isolated valve surgery (IVS) remains undetermined. HYPOTHESIS The pleiotropic effects of statins may produce similar beneficial effects on outcomes after IVS. METHODS A systematic review of the literature was performed investigating the role of statins in bioprosthetic valve replacement. RESULTS Nine observational studies (7 retrospective, 2 prospective) incorporating a total of 18 154 patients were found investigating the role of statin therapy in bioprosthetic valve replacement. CONCLUSIONS There is presently insufficient evidence to recommend routine statin therapy in IVS, unless concomitant hypercholesterolemia or coronary artery disease is present. A prospective study clearly defining the dose, type, and duration of therapy is now required to finally clarify whether statins alone confer a postoperative benefit in these patients.
Collapse
Affiliation(s)
- Jacob Chacko
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | | |
Collapse
|
|
23
|
Mahjoub H, Mathieu P, Sénéchal M, Larose E, Dumesnil J, Després JP, Pibarot P. ApoB/ApoA-I Ratio Is Associated With Increased Risk of Bioprosthetic Valve Degeneration. J Am Coll Cardiol 2013; 61:752-61. [DOI: 10.1016/j.jacc.2012.11.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/12/2012] [Accepted: 11/07/2012] [Indexed: 11/27/2022]
|
|
24
|
Catapano AL, Reiner Z, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegria E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D. ESC/EAS Guidelines for the management of dyslipidaemias The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis 2012; 217:3-46. [PMID: 21882396 DOI: 10.1016/j.atherosclerosis.2011.06.028] [Citation(s) in RCA: 443] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
|
25
|
Meyer SR, Suri RM, Wright RS, Dearani JA, Orszulak TA, Daly RC, Burkhart HM, Park SJ, Schaff HV. Does Metabolic Syndrome Influence Bioprosthetic Mitral Valve Degeneration and Reoperation Rate? J Card Surg 2012; 27:146-51. [DOI: 10.1111/j.1540-8191.2011.01412.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
26
|
Shetty R, Girerd N, Côté N, Arsenault B, Després JP, Pibarot P, Mathieu P. Elevated Proportion of Small, Dense Low-Density Lipoprotein Particles and Lower Adiponectin Blood Levels Predict Early Structural Valve Degeneration of Bioprostheses. Cardiology 2012; 121:20-6. [DOI: 10.1159/000336170] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/18/2011] [Indexed: 11/19/2022]
|
|
27
|
Reiner Ž, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegría E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs RH, Kjekshus JK, Perrone Filardi P, Riccardi G, Storey RF, David W. [ESC/EAS Guidelines for the management of dyslipidaemias]. Rev Esp Cardiol 2011; 64:1168.e1-1168.e60. [PMID: 22115524 DOI: 10.1016/j.recesp.2011.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/16/2011] [Indexed: 01/15/2023]
Affiliation(s)
- Željko Reiner
- University Hospital Center Zagreb, School of Medicine, University of Zagreb, Salata 2, 10 000 Zagreb, Croacia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
28
|
Paraskevas KI, Mikhailidis DP. Carotid artery stenosis and heart valve surgery: a complex scenario. Angiology 2011; 62:597-600. [PMID: 21990547 DOI: 10.1177/0003319711412049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
|
29
|
|
|
30
|
Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegria E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32:1769-818. [PMID: 21712404 DOI: 10.1093/eurheartj/ehr158] [Citation(s) in RCA: 1983] [Impact Index Per Article: 141.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
|
31
|
Gilmanov D, Bevilacqua S, Mazzone A, Glauber M. Do statins slow the process of calcification of aortic tissue valves? Interact Cardiovasc Thorac Surg 2010; 11:297-301. [DOI: 10.1510/icvts.2009.230920] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
|
32
|
&NA;. Definite evidence for the use of statins in conditions other than hyperlipidaemia and atherosclerosis is currently lacking. DRUGS & THERAPY PERSPECTIVES 2010. [DOI: 10.2165/11204260-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
|
33
|
Atorvastatin attenuates post-implant tissue degeneration of cardiac prosthetic valve bovine pericardial tissue in a subcutaneous animal model. Int J Cardiol 2010; 141:68-74. [DOI: 10.1016/j.ijcard.2008.11.174] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 11/26/2008] [Indexed: 11/19/2022]
|
|
34
|
Abstract
Since the introduction of HMG-CoA reductase inhibitors (statins) for lowering lipids, a large amount of data has been published demonstrating their potential benefits in conditions as varied as cancer, osteoporosis, and Alzheimer's dementia. We reviewed the published literature on MEDLINE from articles between 1950 and 2008 on the non-atheroprotective effects of statins and noted consistent benefits of statin use in improving outcomes of ventricular arrhythmias, sudden cardiac death, cardiac transplant rejection, chronic obstructive pulmonary disease, and sepsis. However, for these conditions, the level of evidence was inadequate to recommend statin use. The evidence for improving outcomes in atrial fibrillation, mortality in heart failure, contrast-induced nephropathy, cataract, age-related macular degeneration, sub-arachnoid hemorrhage, osteoporosis, dementia, and cancer incidence was conflicting and inconclusive. Furthermore, we found that most of the literature consists of small observational studies and their conclusions are often not corroborated by results from larger or randomized studies. Pending large, well designed, randomized trials, we conclude that there is no definite evidence for the use of statins in any condition besides hyperlipidemia and atherosclerosis.
Collapse
Affiliation(s)
- Abhimanyu Beri
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA.
| | | | | |
Collapse
|
|
35
|
Mathieu P, Després JP, Pibarot P. The 'valvulo-metabolic' risk in calcific aortic valve disease. Can J Cardiol 2009; 23 Suppl B:32B-39B. [PMID: 17932585 DOI: 10.1016/s0828-282x(07)71008-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Calcific aortic stenosis (AS) has been considered a degenerative and unmodifiable process resulting from aging and 'wear and tear' of the aortic valve. Over the past decade, studies in the field of epidemiology, molecular biology and lipid metabolism have highlighted similarities between vascular atherosclerosis and calcific AS. In particular, work from the Quebec Heart Institute and from that of others has documented evidence of valvular infiltration by oxidized low-density lipoproteins and the presence of inflammatory cells, along with important tissue remodelling in valves explanted from patients with AS. Recent studies have also emphasized the role of visceral obesity in the development and progression of AS. In addition, visceral obesity, with its attendant metabolic complications, commonly referred to as the metabolic syndrome, has been associated with degenerative changes in bioprosthetic heart valves. The purpose of the present review is to introduce the concept of 'valvulo-metabolic risk' and to provide an update on the recent and important discoveries regarding the pathogenesis of heart valve diseases in relation to obesity, and to discuss how these novel mechanisms might translate into clinical practice.
Collapse
Affiliation(s)
- Patrick Mathieu
- Laboratoire d'Etudes Moléculaires des Valvulopathies, Groupe de Recherche en Valvulopathies, Laval Hospital Research Center/Quebec Heart Institute, Department of Surgery, Québec, Quebec.
| | | | | |
Collapse
|
|
36
|
Lee CH. Physiological variables involved in heart valve substitute calcification. Expert Opin Biol Ther 2009; 9:1031-42. [PMID: 19555314 DOI: 10.1517/14712590903085091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Biochemical, histological and genetic studies using in vitro/in vivo models have demonstrated that pathological calcification of bioprosthetic heart valves (BHV) is regulated by various mechanisms associated with physiological variables. The major objective of this review is to characterize physiological variables involved in BHV calcification. This review examines our understanding of the systemic cellular behavior and physiological regulation processes behind BHV calcification and its clinical applications.
Collapse
Affiliation(s)
- Chi H Lee
- University of Missouri-Kansas City, School of Pharmacy, Department of Pharmaceutical Sciences, Kansas City, MO 64110, USA.
| |
Collapse
|
|
37
|
Shetty R, Pibarot P, Audet A, Janvier R, Dagenais F, Perron J, Couture C, Voisine P, Després JP, Mathieu P. Lipid-mediated inflammation and degeneration of bioprosthetic heart valves. Eur J Clin Invest 2009; 39:471-80. [PMID: 19490057 DOI: 10.1111/j.1365-2362.2009.02132.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The durability of bioprosthetic valves is limited by structural valve degeneration (SVD) leading to bioprostheses (BPs) stenosis or regurgitation. We hypothesized that a lipid-mediated inflammatory mechanism is involved in the SVD of BPs. MATERIAL AND METHODS Eighteen Freestyle stentless BP valves were explanted for SVD at a mean time of 5.9 +/- 3 years after implantation and were analysed by immunohistochemistry and transmission electron microscopy (TEM). RESULTS The mean age of the patients was 65 +/- 8 years and there were 11 male and seven female patients. Two of the 18 BPs had macroscopic calcification, whereas the other valves had minimal or no macroscopic calcification. Tears at the commissures leading to regurgitation was present in 16 BPs. Immunohistochemistry showed the presence of oxidized low-density lipoprotein (ox-LDL) and glycosaminoglycans in the fibrosa layer of 13 BPs. Areas with ox-LDL were infiltrated by macrophages (CD68(+)) co-expressing the scavenger receptor CD36 and metalloproteinase-9 (MMP-9). Zymogram showed the active form of MMP-9 within explanted BPs. EM studies revealed the presence of lipid-laden cells featuring foam cells and fragmented collagen. Nonimplanted control BPs obtained from the manufacturer (n = 4) had no evidence of lipid accumulation, inflammatory cell infiltration or expression of MMP9 within the leaflets. CONCLUSIONS These results support the concept that lipid-mediated inflammatory mechanisms may contribute to the SVD of BPs. These findings suggest that modification of atherosclerotic risk factors with the use of behavioural or pharmacological interventions could help to reduce the incidence of SVD.
Collapse
Affiliation(s)
- R Shetty
- Laval University, Quebec, QC, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
38
|
Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation 2009; 119:1034-48. [PMID: 19237674 DOI: 10.1161/circulationaha.108.778886] [Citation(s) in RCA: 459] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Philippe Pibarot
- Department of Medicine, Laval Hospital Research Center/Québec Heart Institute, Laval University, 2725 Chemin Sainte-Foy, Québec, Canada.
| | | |
Collapse
|
|
39
|
Monzack EL, Gu X, Masters KS. Efficacy of simvastatin treatment of valvular interstitial cells varies with the extracellular environment. Arterioscler Thromb Vasc Biol 2009; 29:246-53. [PMID: 19023089 PMCID: PMC2701301 DOI: 10.1161/atvbaha.108.179218] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The lack of therapies that inhibit valvular calcification and the conflicting outcomes of clinical studies regarding the impact of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors on valve disease highlight the need for controlled investigations to characterize the interactions between HMG-CoA reductase inhibitors and valve tissue. Thus, we applied multiple in vitro disease stimuli to valvular interstitial cell (VIC) cultures and examined the impact of simvastatin treatment on VIC function. METHODS AND RESULTS VICs were cultured on 3 different substrates that supported various levels of nodule formation. Transforming growth factor (TGF)-beta1 was also applied as a disease stimulus to VICs on 2-D surfaces or encapsulated in 3-D collagen gels and combined with different temporal applications of simvastatin. Simvastatin inhibited calcific nodule formation in a dose-dependent manner on all materials, although the level of statin efficacy was highly substrate-dependent. Simvastatin treatment significantly altered nodule morphology, resulting in dramatic nodule dissipation over time, also in a substrate-dependent manner. These effects were mimicked in 3-D cultures, wherein simvastatin reversed TGF-beta1-induced contraction. Decreases in nodule formation were not achieved via the HMG-CoA reductase pathway, but were correlated with decreases in ROCK activity. CONCLUSIONS These studies represent a significant contribution to understanding how simvastatin may impact heart valve calcification.
Collapse
Affiliation(s)
- Elyssa L Monzack
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | | | | |
Collapse
|
|
40
|
Mathieu P. Abdominal obesity and the metabolic syndrome: a surgeon's perspective. Can J Cardiol 2008; 24 Suppl D:19D-23D. [PMID: 18787732 DOI: 10.1016/s0828-282x(08)71045-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Over the past decade, a major shift in the clinical risk factors in the population undergoing a cardiac surgery has been observed. In the general population, an increasing prevalence of obesity has largely contributed to the development of cardiovascular disorders. Obesity is a heterogeneous condition in which body fat distribution largely determines metabolic perturbations. Consequently, individuals characterized by increased abdominal fat deposition and the so-called metabolic syndrome (MetS) have a higher risk of developing coronary artery disease. Recent studies have also emphasized that visceral obesity is a strong risk factor for the development of heart valve diseases. In fact, individuals characterized by visceral obesity and its metabolic consequences, such as the small dense low-density lipoprotein phenotype, have a faster progression rate of aortic stenosis, which is related to increased valvular inflammation. Furthermore, the degenerative process of implanted bioprostheses is increased in subjects with the MetS and/or diabetes, suggesting that a process akin to atherosclerosis could be involved in the failure of bioprostheses. In addition to being an important risk factor for the development of cardiovascular disorders, the MetS is increasing the operative mortality risk following coronary artery bypass graft surgery. Thus, recent evidence supports visceral obesity as a global risk factor that is affecting the development of many heart disorders, and that is also impacting negatively on the results of patients undergoing surgical treatment for cardiovascular diseases. In the present paper, recent concepts surrounding the MetS and its implications in various cardiovascular disorders are reviewed along with the clinical implications.
Collapse
Affiliation(s)
- Patrick Mathieu
- Laval Hospital, Department of Surgery, Laval University, Sainte-Foy, Quebec.
| |
Collapse
|
|
41
|
Hakuno D, Kimura N, Yoshioka M, Fukuda K. Molecular mechanisms underlying the onset of degenerative aortic valve disease. J Mol Med (Berl) 2008; 87:17-24. [DOI: 10.1007/s00109-008-0400-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 08/20/2008] [Accepted: 08/22/2008] [Indexed: 12/31/2022]
|
|
42
|
Migneco F, Hollister SJ, Birla RK. Tissue-engineered heart valve prostheses: ‘state of the heart’. Regen Med 2008; 3:399-419. [DOI: 10.2217/17460751.3.3.399] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In this article, we will review the current state of the art in heart valve tissue engineering. We provide an overview of mechanical and biological replacement options, outlining advantages and limitations of each option. Tissue engineering, as a field, is introduced, and specific aspects of valve tissue engineering are discussed (e.g., biomaterials, cells and bioreactors). Technological hurdles, which need to be overcome for advancement of the field, are also discussed.
Collapse
Affiliation(s)
- Francesco Migneco
- Section of Cardiac Surgery, the University of Michigan, B560 Medical Science Research Building II, 1150 West Medical Center Drive, Ann Arbor, MI 48109-2110, USA
| | - Scott J Hollister
- Department of Biomedical Engineering, the University of Michigan, Ann Arbor, MI 48109-2110, USA
| | - Ravi K Birla
- Section of Cardiac Surgery, the University of Michigan, B560 Medical Science Research Building II, 1150 West Medical Center Drive, Ann Arbor, MI 48109-2110, USA
| |
Collapse
|
|
43
|
Price L, Sniderman A, Omerglu A, Lachapelle K. Bioprosthetic valve degeneration due to cholesterol deposition in a patient with normal lipid profile. Can J Cardiol 2007; 23:233-4. [PMID: 17347697 PMCID: PMC2647874 DOI: 10.1016/s0828-282x(07)70751-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Hypercholesterolemia has been identified as a risk factor for bioprosthetic valvular degeneration, and it has been suggested that statin therapy reduces this risk. The case of a 77-year-old man with low levels of low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B who developed marked LDL-C crystal deposition and a severe foreign body giant cell reaction 21.5 years after aortic bioprosthetic replacement is reported. This observation confirms that cholesterol deposition contributes to bioprosthetic valve degeneration, but that this can occur even in patients with low levels of LDL-C. It suggests that the characteristics of the valve are more critical than the patient's level of LDL-C.
Collapse
Affiliation(s)
| | | | | | - Kevin Lachapelle
- Correspondence and reprints: Dr Kevin Lachapelle, McGill University Health Centre, 687 Ave Des Pins, Montreal, Quebec H3A 1A1. Telephone 514-843-1519, fax 514-843-1602, e-mail
| |
Collapse
|
|
44
|
Blanchard L, Collard CD. Non-antiarrhythmic agents for prevention of postoperative atrial fibrillation: role of statins. Curr Opin Anaesthesiol 2007; 20:53-6. [PMID: 17211168 DOI: 10.1097/aco.0b013e328013d9fd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Atrial fibrillation is the most common arrhythmia following cardiac surgery, having both serious medical and socioeconomic consequences. Although there are established antiarrhythmic agents for preventing and treating postoperative atrial fibrillation, these therapies are neither 100% reliable, nor without risks and limitations. Thus, there remains a strong need for non-antiarrhythmic, adjunctive therapies for the prevention of postoperative atrial fibrillation. RECENT FINDINGS Long-term statin administration in ambulatory patients is associated with a reduced risk of adverse cardiovascular events, including death, myocardial infarction, stroke, renal dysfunction and atrial fibrillation. Recent evidence suggests, however, that statins may also reduce the risk of acute adverse outcomes following invasive procedures, including postoperative atrial fibrillation. Although the exact mechanisms by which statins may reduce postoperative atrial fibrillation are unclear, accumulating evidence suggests that statins exert multiple effects independent of their effect on LDL cholesterol. For example, in patients with acute coronary syndromes, statin therapy has been shown to modulate remodeling of the cardiac extracellular matrix and to reduce markers of inflammation, including C-reactive protein, serum amyloid A, tumor necrosis factor-alpha, and IL-6. SUMMARY Perioperative statin therapy may represent an important non-antiarrhythmic, adjunctive therapeutic strategy for the prevention of postoperative atrial fibrillation.
Collapse
Affiliation(s)
- Lawrence Blanchard
- Baylor College of Medicine, Division of Cardiovascular Anesthesia, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, Texas 77030, USA
| | | |
Collapse
|
|
45
|
Antonini-Canterin F, Corrado G, Faggiano P, Popescu BA, Carerj S, La Carrubba S, Zuppiroli A, Nicolosi GL. A medical therapy for aortic valve sclerosis and aortic valve stenosis? Rationale of the ASSIST study (Asymptomatic aortic Sclerosis/Stenosis: Influence of STatins): a large, observational, prospective, multicenter study of the Italian Society of Cardiovascular Echography. J Cardiovasc Med (Hagerstown) 2006; 7:464-9. [PMID: 16801806 DOI: 10.2459/01.jcm.0000234763.76132.0d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Progression of sclerosis and stenosis is substantially unpredictable in the individual patient: in some cases it is very slow, in others it is accelerated. In addition, different patterns of progression (linear and non-linear) are possible. It has been suggested that the aortic valve lesion can be considered a form within the spectrum of the same atherosclerotic disease. In this context it seemed reasonable to hypothesize that targeted medical therapy could retard the progression of the disease. In particular HMG-CoA reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors have been tested. The first experimental and clinical studies are now available, even though they are not conclusive to date. Large, prospective, randomized trials are ideally needed, but they are quite difficult, if not even impossible, to realize in practice. The ASSIST study (Asymptomatic aortic Sclerosis/Stenosis: Influence of STatins) of the Italian Society of Cardiovascular Echography aims to create a large, prospective, observational investigation, involving many centers of echocardiography and thousands of patients, in order to provide from the real clinical world at least some of the answers to this unsolved question.
Collapse
|
|
46
|
Veinot JP. Pathology of inflammatory native valvular heart disease. Cardiovasc Pathol 2006; 15:243-251. [PMID: 16979030 DOI: 10.1016/j.carpath.2006.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 04/27/2006] [Indexed: 12/25/2022] Open
Abstract
Rheumatic disease is an important cause of inflammatory native heart valve disease. However, with increased understanding of the pathoetiology of valve disease and valve injury, it is evident that inflammation may play a role in many valve disorders. We are only beginning to understand these complex processes. With increasing knowledge that many of these processes are active, there may be opportunity for intervention or even prevention.
Collapse
Affiliation(s)
- John P Veinot
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
|
47
|
Briand M, Pibarot P, Després JP, Voisine P, Dumesnil JG, Dagenais F, Mathieu P. Metabolic syndrome is associated with faster degeneration of bioprosthetic valves. Circulation 2006; 114:I512-7. [PMID: 16820629 DOI: 10.1161/circulationaha.105.000422] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have reported similarities between calcification of the native aortic valve and atherosclerosis. Recent studies also suggested that hypercholesterolemia may be a risk factor for calcific degeneration of bioprosthetic valves. The metabolic syndrome (MS) is associated with a higher risk of vascular atherosclerosis. We thus hypothesized that the atherogenic features of MS could accelerate bioprosthetic valve degeneration. METHODS AND RESULTS We included 217 patients who underwent aortic valve replacement with a bioprosthetic valve in the study. Of these patients, 71 patients (33%) had MS defined according to the modified criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III. The annualized increase in mean transprosthetic gradient and the worsening of transprosthetic regurgitation measured by Doppler echocardiography were used to assess the deterioration of valve hemodynamic function. Patients with MS had higher progression of gradient (+4+/-5 mm Hg/year versus +2+/-2 mm Hg/year, P<0.001), higher proportion of > or = 1/3 degree worsening of regurgitation (25% versus 12%, P=0.02), and higher proportion of valve function deterioration defined as regurgitation worsening and/or > or = 3 mm Hg/year increase in gradient (41% versus 25%, P=0.02) when compared with patients without MS. On multivariate analysis, MS was an independent predictor of gradient progression (P=0.01), regurgitation worsening (P=0.02), and valve function deterioration (P=0.02). The other independent predictors were diabetes, renal insufficiency, and higher mean gradient at baseline. CONCLUSIONS This is the first study to report that the MS is independently associated with faster bioprosthetic valve degeneration. This study could pave the way for the development of a new medical therapy able to significantly reduce the structural valve deterioration of bioprostheses.
Collapse
Affiliation(s)
- Martin Briand
- Laval Hospital Research Center/Québec Heart Institute, Laval University, 2725 Chemin Sainte-Foy, Sainte-Foy, Québec, Canada, G1V-4G5
| | | | | | | | | | | | | |
Collapse
|
|
48
|
Collard CD, Body SC, Shernan SK, Wang S, Mangano DT. Preoperative statin therapy is associated with reduced cardiac mortality after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2006; 132:392-400. [PMID: 16872968 DOI: 10.1016/j.jtcvs.2006.04.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 04/24/2006] [Accepted: 04/27/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Statin therapy in ambulatory populations is associated with a significant reduction in adverse cardiovascular events, including death and myocardial infarction. Much less is known about the beneficial effects of statins on acute perioperative cardiovascular events. The purpose of this study was to determine whether preoperative statin therapy is associated with a reduced risk of early cardiac death or nonfatal, in-hospital postoperative myocardial infarction after primary, elective coronary artery bypass graft surgery requiring cardiopulmonary bypass. METHODS The Multicenter Study of Perioperative Ischemia (McSPI) Epidemiology II Study was a prospective, longitudinal study of 5436 patients undergoing coronary artery bypass graft surgery between November 1996 and June 2000 at 70 centers in 17 countries. The present study consisted of a pre-specified subset of these subjects divided into patients receiving (n = 1352) and not receiving (n = 1314) preoperative statin therapy. To control for potential bias related to use of statin therapy, the study estimated propensity scores by logistic regression to determine the predicted probability of inclusion in the "statin" group. Multivariate, stepwise logistic regression was then performed, controlling for patient demographics, medical history, operative characteristics, and propensity score to determine whether preoperative statin therapy was independently associated with a reduction in the risk of early (DOS-POD3) cardiac death and/or nonfatal, in-hospital postoperative myocardial infarction. RESULTS Preoperative statin therapy was independently associated with a significant reduction (adjusted odds ratio [OR] 0.25; 95% confidence intervals [CI] 0.07-0.87) in the risk of early cardiac death after primary, elective coronary bypass surgery (0.3% vs 1.4%; P < .03), but was not associated with a reduced risk of postoperative nonfatal, in-hospital myocardial infarction (7.9% vs 6.2%; P = not significant). Discontinuation of statin therapy after surgery was independently associated with a significant increase in late (POD4-discharge) all-cause mortality (adjusted OR 2.64; 95% CI 1.32-5.26) compared with continuation of statin therapy (2.64% vs 0.60%; P < .01). This was true even when controlling for the postoperative discontinuation of aspirin, beta-blocker, or angiotensin-converting enzyme inhibitor therapy. Discontinuation of statin therapy after surgery was also independently associated with a significant increase in late cardiac mortality (adjusted OR 2.95; 95% CI 1.31-6.66) compared with continuation of statin therapy (1.91% vs 0.45%; P < 0.01). CONCLUSIONS Preoperative statin use is associated with reduced cardiac mortality after primary, elective coronary artery bypass grafting. Postoperative statin discontinuation is associated with increased in-hospital mortality. Although further randomized trials are needed to confirm these findings, these data suggest the importance of perioperative statin administration.
Collapse
Affiliation(s)
- Charles D Collard
- Baylor College of Medicine, Division of Cardiovascular Anesthesiology, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, Tex, USA.
| | | | | | | | | |
Collapse
|
|
49
|
Colli A, Gherli T, Mestres CA, Pomar JL. Degeneration of native and tissue prosthetic valve in aortic position: do statins play an effective role in prevention? Int J Cardiol 2006; 116:144-52. [PMID: 16828903 DOI: 10.1016/j.ijcard.2006.03.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 02/20/2006] [Accepted: 03/11/2006] [Indexed: 12/28/2022]
Abstract
Degenerative aortic valve stenosis is a common disease in western countries. When it becomes severe, it confers significant morbidity and mortality. Aortic stenosis has been recognized as a complex inflammatory and highly regulated process with histological and immunochemical similarities with the process of atherosclerosis. Hypertension, smoking and diabetes mellitus have consistently been linked to the development of aortic stenosis. Endothelial injury or other processes that contribute to coronary disease may play a role in calcific aortic stenosis. Several observational studies suggests that the key factors of aortic stenosis are lipoproteins and that medical therapies with cholesterol lowering drugs may retard its progression. Similarly, it has been suggested that the process of degeneration of the tissue heart valve has been associated with the same risk factors of atherosclerosis and shares many histological and molecular characteristics. Assuming all this concept, and evaluating the results of a retrospective study it has been suggested to use statin also as medical therapy able to prevent tissue valve degeneration. Randomized controlled clinical trials will be needed to demonstrate the role of lipid intervention to prevent the progression of aortic stenosis and the degeneration of tissue heart valves.
Collapse
Affiliation(s)
- Andrea Colli
- Department of Cardiac Surgery, University of Parma, Italy.
| | | | | | | |
Collapse
|
|
50
|
Antonini-Canterin F, Zuppiroli A, Baldessin F, Popescu BA, Nicolosi GL. Is there a role of statins in the prevention of aortic biological prostheses degeneration. Cardiovasc Ultrasound 2006; 4:26. [PMID: 16805917 PMCID: PMC1550427 DOI: 10.1186/1476-7120-4-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 06/29/2006] [Indexed: 12/05/2022] Open
Abstract
It has been recently observed that statins might slow the progression of aortic stenosis or sclerosis. Preliminary reports suggested a similar positive effect in reducing the degeneration of aortic valve bioprostheses even though this hypothesis should be further proven and supported by new data. In this review the present evidences of the possible effects of statins in this field are discussed.
Collapse
Affiliation(s)
| | - Alfredo Zuppiroli
- U.O. Cardiologia, Ospedale S. Maria Annunziata, Azienda Sanitaria 10, Firenze, Italy
| | - Ferdinando Baldessin
- Unità Operativa di Cardiologia, A.R.C. Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy
| | | | - Gian Luigi Nicolosi
- Unità Operativa di Cardiologia, A.R.C. Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy
| |
Collapse
|