Antimineralization treatment and patient-prosthesis mismatch are major determinants of the onset and incidence of structural valve degeneration in bioprosthetic.

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Presentation transcript:

Antimineralization treatment and patient-prosthesis mismatch are major determinants of the onset and incidence of structural valve degeneration in bioprosthetic heart valves Willem Flameng, MD, PhD, Filip Rega, MD, PhD, Monique Vercalsteren, RN, Paul Herijgers, MD, PhD, Bart Meuris, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 147, Issue 4, Pages 1219-1224 (April 2014) DOI: 10.1016/j.jtcvs.2013.03.025 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Freedom from reoperation (solid line) and SVD (dashed line). It is clear that stringent echocardiographic follow-up leads to detection of SVD in a phase when reoperation is not required (yet). Numbers at risk are shown at 4, 8, and 12 years. SVD, Structural valve degeneration; Redo, reoperation. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1219-1224DOI: (10.1016/j.jtcvs.2013.03.025) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Freedom from SVD (all forms) in patients with a treated or a nontreated valve (log-rank P < .0001). B, Freedom from stenotic-type SVD in patients with a treated or a nontreated valve (log-rank P < .0001). C, Freedom from regurgitation-type SVD in patients with a treated or a nontreated valve (log-rank P = .0009). Numbers at risk are shown at 4, 8 and 12 years. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1219-1224DOI: (10.1016/j.jtcvs.2013.03.025) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Freedom from stenotic-type SVD in patients with or without PPM (log-rank P = .003). Numbers at risk are shown at 4, 8, and 12 years. PPM, Patient-prosthesis mismatch. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1219-1224DOI: (10.1016/j.jtcvs.2013.03.025) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Additive effect of valve anticalcification treatment and PPM on freedom from SVD (all forms). Black curves represent treated valves; red curves represent untreated valves. Patients with PPM are represented with dashed lines. Patients having PPM and receiving an untreated valve show a freedom from SVD at 10 years of follow-up of only 59.8 ± 7.0% versus 88.7 ± 3.6% in patients having PPM but receiving a treated valve (P < .0001). In patients not having PPM, the corresponding values were 78.0 ± 4.3% and 92.7 ± 3.4% for nontreated versus treated valves, respectively (P < .01). Numbers at risk are shown at 4, 8, and 12 years. PPM, Patient-prosthesis mismatch. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1219-1224DOI: (10.1016/j.jtcvs.2013.03.025) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions