Degeneration of native and tissue prosthetic valve in aortic position: Do statins play an effective role in prevention?

Colli, Andrea; Gherli, Tiziano; Mestres, Carlos A.; Pomar, José L.

doi:10.1016/j.ijcard.2006.03.047

Cited by 19 publications

(16 citation statements)

References 85 publications

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“…4 In the present study, the use of statin therapy did not appear to significantly influence the degeneration of bioprosthetic valves; however, controversy remains about this issue, 19 and controlled prospective, randomized trials would be advisable to draw any conclusive information in this regard.…”

Section: Discussionmentioning

confidence: 52%

“…It is realistic that all 3 mechanisms work together to determine postimplantation prosthetic tissue degradation. 4 The potential mechanism responsible for SVD in type 2 DM patients is still largely unclear; however, oxidative stress leading to DNA damage is implicated in progressive chronic degenerative process secondary to DM. Indeed, increased production of highly aggressive reactive oxygen species under hyperglycemic conditions is considered the main trigger of severe chronic complications such as degenerative valve disease.…”

Section: Potential Mechanisms Responsible For Svd In Dmmentioning

confidence: 99%

“…2 Moreover, it has been suggested that statins could slow the progression of bioprosthetic valve degeneration. 3,4 Finally, the metabolic syndrome (MS), a cluster of atherogenic, inflammatory, and atherothrombotic abnormalities linked to abdominal obesity and insulin resistance, has been reported to be an independent predictor of poor prognosis in native valve disease and of faster degeneration of implanted bioprosthetic valves. 5,6 Clinical Perspective on p 614…”

mentioning

confidence: 99%

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Type 2 Diabetes Mellitus Is Associated With Faster Degeneration of Bioprosthetic Valve

et al. 2012

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resulted in 6184 patients (mean age 71.3Ϯ5.4 years, 60.1% male) being enrolled. Of these patients, 1731 (27.9%) had type 2 DM. The propensity score-matching algorithm successfully matched 1113 patients with type 2 DM with the same number of no-DM patients. The postmatching standard differences were less than 0.1 for each of the covariates, and 64.2% of DM patients were matched. The early (30 days) mortality rate was 7.8% (nϭ87) versus 2.9% (nϭ33) in patients with or without type 2 DM (PϽ0.001), respectively. Seven-year freedom from valve deterioration was significantly lower in patients with DM (73.2% [95% confidence interval, 61.6 -85.5] versus 95.4% [95% confidence interval, 83.9 -100], PϽ0.001). In Cox regression models with robust SEs that accounted for the clustering of matched pairs, DM was the strongest predictor of structural valve degeneration (hazard ratio 2.39 [95% confidence interval 2.28 -3.52]). When we allowed for interaction between type 2 DM and other key risk factors, DM remained a significant predictor beyond any potentially associated variable. Conclusions-Patients

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Section: Discussionmentioning

confidence: 52%

Section: Potential Mechanisms Responsible For Svd In Dmmentioning

confidence: 99%

mentioning

confidence: 99%

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Type 2 Diabetes Mellitus Is Associated With Faster Degeneration of Bioprosthetic Valve

et al. 2012

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“…3,4 Unfortunately, this increasing clinical use of bioprosthetic valves does not reflect our understanding and/or knowledge of, the various factors leading to its eventual failure. 14 The only option for bioprosthetic valve failure is repeat high-risk open-heart surgery, which is an undesired outcome.…”

Section: Bioprosthetic Structural Valve Deterioration (Svd)mentioning

confidence: 99%

“…14,40 The immune response following bioprosthetic valve implantation has been categorized into three possible processes. 40,41 Firstly, that associated with postsurgical wound healing.…”

Section: Inflammation and Bioprosthetic Structural Valve Deteriorationmentioning

confidence: 99%

HMG-COA Reductase Inhibitors Do not Attenuate the Inflammatory Response Associated With Glutaraldehyde-Fixed Bioprosthetic Heart Valve Conduits

Kumar

Azordegan

Durston

et al. 2013

Canadian Journal of Cardiology

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ABSTRACT:Evidence suggests that there is an immunological response of the recipient to xenograft bioprosthetic heart valves. Information on the impact of HMG-CoA reductase inhibitors (statins) and their anti-inflammatory properties on bioprosthetic valve failure remains limited. We sought to examine the efficacy of statin therapy in a rodent model of bioprosthetic valve implantation.To mimic the human scenario, fresh or glutaraldehyde-fixed aortic valve root conduits from Lewis rats or Hartley guinea pigs were microsurgically implanted intravascularly into the infra-renal aorta of Lewis rats. The syngeneic control group consisted of a fresh rat valve conduit implanted into a rat. The xenogeneic control group consisted of a glutaraldehyde-fixed guinea pig valve conduit implanted into a rat. Treatment groups consisted of xenogeneic groups treated with either daily steroids or statins.Overall, steroid treatment attenuated the inflammatory response observed within the xenogeneic glutaraldehyde-fixed valve conduits. Treatment with statins did not decrease this inflammatory response.ii. ACKNOWLEDGEMENTS:

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Molecular mechanisms underlying the onset of degenerative aortic valve disease

et al. 2008

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Morbidity from degenerative aortic valve disease is increasing worldwide, concomitant with the ageing of the general population and the habitual consumption of diets high in calories and cholesterol. Immunohistologic studies have suggested that the molecular mechanism occurring in the degenerate aortic valve resembles that of atherosclerosis, prompting the testing of HMG CoA reductase inhibitors (statins) for the prevention of progression of native and bioprosthetic aortic valve degeneration. However, the effects of these therapies remain controversial. Although the molecular mechanisms underlying the onset of aortic valve degeneration are largely unknown, research in this area is advancing rapidly. The signaling components involved in embryonic valvulogenesis, such as Wnt, TGF-beta(1), BMP, and Notch, are also involved in the onset of aortic valve degeneration. Furthermore, investigations into extracellular matrix remodeling, angiogenesis, and osteogenesis in the aortic valve have been reported. Having noted avascularity of normal cardiac valves, we recently identified chondromodulin-I (chm-I) as a crucial anti-angiogenic factor. The expression of chm-I is restricted to cardiac valves from late embryogenesis to adulthood in the mouse, rat, and human. In human degenerate atherosclerotic valves, the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinases and angiogenesis is observed in the area of chm-I downregulation. Gene targeting of chm-I resulted in VEGF expression, angiogenesis, and calcification in the aortic valves of aged mice, and aortic stenosis is detected by echocardiography, indicating that chm-I is a crucial factor for maintaining normal cardiac valvular function by preventing angiogenesis. The present review focuses on the animal models of aortic valve degeneration and recent studies on the molecular mechanisms underlying the onset of degenerative aortic valve disease.

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Degeneration of native and tissue prosthetic valve in aortic position: Do statins play an effective role in prevention?

Cited by 19 publications

References 85 publications

Type 2 Diabetes Mellitus Is Associated With Faster Degeneration of Bioprosthetic Valve

Type 2 Diabetes Mellitus Is Associated With Faster Degeneration of Bioprosthetic Valve

HMG-COA Reductase Inhibitors Do not Attenuate the Inflammatory Response Associated With Glutaraldehyde-Fixed Bioprosthetic Heart Valve Conduits

Molecular mechanisms underlying the onset of degenerative aortic valve disease

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