Elevated lipoprotein(a) levels (≥ 105 nmol/L) were not significantly associated with an earlier need for reintervention due to bioprosthetic aortic valve degeneration (HR 0.81).
Cohort (n=389)
No
Do elevated Lp(a) levels reduce the time to reintervention in patients with aortic bioprosthetic valves?
Elevated Lp(a) levels are not associated with earlier structural degeneration and need for reintervention in patients with aortic bioprosthetic valves, unlike in native aortic stenosis.
Effect estimate: HR 0.81 (95% CI 0.58-1.13)
Absolute Event Rate: 4001% vs 3467%
p-value: p=0.215
Abstract Background The expanding use of bioprosthetic aortic valve replacements has raised concerns regarding the long-term durability of bioprosthetic valve prostheses. While lipoprotein(a) Lp(a) is implicated in the pathogenesis of native aortic valve stenosis, its impact on bioprosthetic valve degeneration leading to reintervention remains unclear. Objective To evaluate the association between Lp(a) levels and structural degeneration of aortic bioprosthetic valves in patients undergoing secondary aortic valve procedure. Methods We retrospectively analyzed 389 patients with available Lp(a) values who underwent replacement of a degenerated aortic bioprosthetic valves between February 2001 and September 2024. Endpoint was the interval from initial surgical aortic valve replacement (SAVR) to the second aortic valve procedure either as transvascular or surgical replacement. Patients were stratified by Lp(a) levels into low (< 105 nmol/L) and high (≥ 105 nmol/L) Lp(a) groups. Associations between Lp(a) levels and time-to-reintervention were assessed using Kaplan–Meier survival analysis. Results Out of an initial cohort of 909 patients, 389 met the inclusion criteria. Of these, 296 patients showed low and 93 high Lp(a) levels. Baseline characteristics were comparable between both groups. The median time from initial valve implantation to the second aortic valve intervention did not differ significantly by Lp(a) group. Kaplan–Meier analysis demonstrated no significant association between elevated Lp(a) and time-to-reintervention (hazard ratio HR 0.81; 95% confidence interval CI 0.58 – 1.13; p = 0.215). Conclusions In this cohort of patients undergoing secondary aortic valve procedure, elevated Lp(a) levels were not associated with earlier need for reintervention. Unlike in native aortic stenosis, our findings do not support a clinically meaningful role for Lp(a) in bioprosthetic aortic valve degeneration. Graphical Abstract
Syryca et al. (Mon,) conducted a cohort in Degenerated aortic bioprosthetic valves (n=389). High Lipoprotein(a) vs. Low Lipoprotein(a) (< 105 nmol/L) was evaluated on Time-to-reintervention (HR 0.81, 95% CI 0.58-1.13, p=0.215). Elevated lipoprotein(a) levels (≥ 105 nmol/L) were not significantly associated with an earlier need for reintervention due to bioprosthetic aortic valve degeneration (HR 0.81).