title: Effect of preoperative statin therapy on patients undergoing isolated and combined valvular heart surgery.
abstract: BACKGROUND
  It is unknown whether patients undergoing valve surgery benefit from preoperative statin therapy. We examined the effects of statin treatment in a large group of patients undergoing valve surgery.
  
  
  METHODS
  Between October 2001 and May 2008, a total of 10,061 patients underwent isolated or combined valve surgery at our institution. Patients were divided into those who received preoperative statin therapy (group 1, n = 4,216) versus those who did not receive statin therapy (group 2, n = 5,538). Patients in whom preoperative statin therapy status was unknown (n = 307) were excluded. Follow-up survival information was available in all patients.
  
  
  RESULTS
  Group 1 patients had more comorbidities, were more likely to undergo concomitant coronary artery bypass grafting (46.0% versus 20.7%; p < 0.001), and had a higher mean EuroSCORE predicted risk of mortality (12.4% +/- 13.5% versus 11.5% +/- 13.9%; p = 0.002). Patients receiving preoperative statin therapy had a higher incidence of low cardiac output syndrome (8.4% versus 6.0%; p < 0.001) and the combined cardiac outcome of myocardial infarction, low cardiac output syndrome, and 30-day mortality (11.8% versus 9.6%; p < 0.001) by univariate analysis. Multivariable analyses, however, revealed no significant effect of statin therapy on perioperative cardiac outcomes. Cox multivariable regression revealed no significant effect of statin therapy on long-term survival in the entire patient cohort, but statin therapy was associated with a long-term survival benefit (hazard ratio, 0.81; 95% confidence interval, 0.70 to 0.93; p = 0.003) in patients who underwent concomitant coronary artery bypass grafting.
  
  
  CONCLUSIONS
  Our large series failed to detect a protective effect of preoperative statin therapy on perioperative outcomes or long-term survival in patients undergoing isolated valve surgery. Valve patients undergoing concomitant coronary artery bypass grafting, however, appear to receive a long-term survival benefit from statins.
authors.affiliation: Department of Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany. michael.borger@med.uni-leipzig.de
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Franka
authors.initials: F
authors.lastname: Borger
authors.forename: Ardawan
authors.initials: A
authors.lastname: Rastan
authors.forename: Torsten
authors.initials: T
authors.lastname: Doenst
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality; D001026:Coronary Artery Bypass; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D015996:Survival Rate
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors