Wednesday, 28 September 2011

Real World Data for Biological Valve Patients

Reoperation of Left Heart Valve Bioprostheses According to Age at Implantation
This retrospective study, published recently in Circulation of a large number of patients undergoing aortic or mitral valve replacement with biological valves is interesting. I do not agree with their opening gambit that evidence for implantation of biological valves in younger patients is growing - -it isn't. It does however provides real world data on the chances of reoperation after implantation of a biological valve in the aortic or mitral positions. What I also found interesting is the fact that having concomitant coronary artery grafts seemed to 'protect' against the need for reoperation. There are 3 possible reasons for this - 2 nihilistic and the third hopeful. Patients are not surviving long enough for reoperation to take place. We know having coronary disease is associated with shortened survival when compared to a valve surgery patient without coronary disease. Surgeons are just not operating on patients with a deteriorating valve in the presence of patient coronary grafts - such procedures are technically hazardous. Statins, that all patients with coronary disease take, protects the biological valve against late deterioration. Many people do believe this and there may be mechanistic reasons why it may be so. There is however no strong evidence for this, so far.