Prevention of bioprosthetic porcine and pericardial valve failure and improved patient survival using HMG-CoA reductase inhibitors

Background: Bioprosthetic heart valve failure results in substantial morbidity and mortality. Bioprosthetic heart valve (BPV) and other bioprosthetic devices have dysfunction and failure modes that are many times due to lipid adsorption and calcific degeneration. Lipid adsorption and calcific degeneration is also a common cause of coronary artery and saphenous vein graft dysfunction and failure that could be prevented or reduced with lipid lowering drugs. We hypothesized that treatment of bioprosthetic heart valves with HMG CoA reductase inhibitors, which have been used successfully to reduce morbidity and mortality of atherosclerotic lesions may reduce BPV failure and need for replacement. Methods: During 1976-1996, 439(342) porcine valves and during 1991-2002, 1021(673) pericardial valves were used for isolated aortic valve replacement by our surgical group. Thirty-seven porcine and 286 pericardial valve patients have reported any use of statins. Patient survival and SVD were analyzed retrospectively. Results: The age distribution of the groups are very similar for both porcine and pericardial valves. The mean and maximum follow-up years were 6.5 and 18 years for porcine, 2.5 and 10 years for pericardial. For porcine, 15 years survival were 41 ±12% for patients in the lipid lowering group and 10±2% for patients with no use of these drugs (p<0.001). For pericardial, 10 years survival were 72±6% for and 30±7% for (p<0.001) respectively. In patients receiving lipid-lowering drugs no SVD was observed in porcine and 2 in pericardial (p<0.03). Conclusion: In this retrospective study, the use of lipid lowering drugs is associated with a remarkable reduction of bioprosthetic valve dysfunction requiring valve replacement as well as a highly significant improvement of patient survival. Prevention of lipid and inflammatory reduction of bioprosthetic implants with lipid lowering drugs may be the explanation for this effect and may point to an important improvement in bioprosthetic valve durability and function. Similar prevention of other bioprosthetic calcification and failure may also be possible.