title: Antimineralization treatment and patient-prosthesis mismatch are major determinants of the onset and incidence of structural valve degeneration in bioprosthetic heart valves.
abstract: BACKGROUND
  We examined the influence of multiple valve-related parameters on the onset and incidence of valve degeneration in aortic bioprostheses through detailed echocardiographic follow-up.
  
  
  METHODS
  In 648 patients (mean age, 73.8 ± 4.9 years) receiving an aortic valve bioprosthesis, long-term clinical (mean, 7.5 ± 3.2 years) and echocardiographic (mean, 6.5 ± 3.4 years) follow-up were performed. The occurrence of signs of structural valve degeneration (stenosis type and regurgitation type) was studied through multivariate analysis, including tissue origin, design and label size of the prosthesis, effective orifice area index (EOAi), patient-prosthesis mismatch (PPM; EOAi <0.85 cm(2)/m(2)), and antimineralization treatment.
  
  
  RESULTS
  Structural valve degeneration (SVD) was diagnosed in 12.6% of patients. In 7.6%, it was of the stenosis type (S-SVD); in 5%, it was the regurgitation type (R-SVD). The absence of antimineralization treatment is an independent predictor of SVD, S-SVD, and R-SVD. Patient-prosthesis mismatch is an independent predictor of SVD and S-SVD, but not of R-SVD. Patients receiving a nontreated valve show a freedom of SVD at 10 years follow-up of 70.1 ± 4.3% versus 90.9 ± 3.6% in patients receiving a treated valve (P < .0001). Patients having PPM and receiving a nontreated valve show a freedom of SVD at 10 years of follow-up of only 59.8 ± 7.0% versus 88.7 ± 3.6% in patients also 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).
  
  
  CONCLUSIONS
  Antimineralization treatment of bioprosthetic heart valves is effective and reduces the incidence of SVD significantly. Because valve type and size are determined at the moment of implantation, the surgeon carries an important responsibility in protecting the patient from valve degeneration.
authors.affiliation: Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Willem
authors.initials: W
authors.lastname: Flameng
authors.affiliation: Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Rega
authors.affiliation: Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Monique
authors.initials: M
authors.lastname: Vercalsteren
authors.affiliation: Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.affiliation: Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium. Electronic address: bart.meuris@uzleuven.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Meuris
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008903:Minerals; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D011475:Prosthesis Failure
chemical_list: D008903:Minerals