What question did this study set out to answer?

The study aims to explore the relationship between vitamin K antagonists and structural valve deterioration in bioprosthetic aortic valves.

March 18, 2026

Vitamin K antagonists and structural valve deterioration in bioprosthetic aortic valves

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Bioprosthetic aortic valve replacement (n=123). Intervention: Vitamin K antagonist (VKA) vs. Non-VKA (exposure <3 months). Primary outcome: VARC-3-defined structural valve deterioration (SVD) (aHR 2.14, 95% CI 1.08-4.26, p=0.030).

Key Result

Postoperative vitamin K antagonist exposure significantly increased the risk of structural valve deterioration (aHR 2.14) compared to non-users after bioprosthetic aortic valve replacement.

Key Points

The study aims to explore the relationship between vitamin K antagonists and structural valve deterioration in bioprosthetic aortic valves.
Analyzed data from patients with bioprosthetic aortic valve replacement (AVR)
Examined the association between vitamin K antagonists and structural valve deterioration
Considered different prosthesis materials and patient characteristics
Vitamin K antagonists and porcine bioprostheses were independently linked to structural valve deterioration
Identified the need for careful consideration of long-term effects of vitamin K antagonists in treatment strategies

Study Design

Type

Cohort (n=123)

Multicenter

Structured PICO

Does postoperative Vitamin K antagonist exposure increase structural valve deterioration in patients with bioprosthetic aortic valves?

Population

123 patients who underwent surgical bioprosthetic aortic valve replacement (AVR) between 2010 and 2025, mean age 71.3 years, 65% male.

Intervention

Postoperative Vitamin K antagonist (VKA) exposure (cumulative use ≥3 months or time-varying).

Comparator

No VKA exposure or cumulative use <3 months.

Outcome

Development of structural valve deterioration (SVD) according to VARC-3 criteria.surrogate

Postoperative Vitamin K antagonist exposure and the use of porcine bioprostheses are independently associated with an increased risk of structural valve deterioration after surgical aortic valve replacement.

Main Result

Effect estimate: aHR 2.14 (95% CI 1.08-4.26)

Absolute Event Rate: 43.1% vs 18.1%

p-value: p=0.030

Limitations

Retrospective, single-center analysis with a relatively small sample size
Residual confounding cannot be fully excluded, particularly confounding by indication for VKA
Potential exposure misclassification due to retrospective collection of VKA start/stop dates
Echocardiographic follow-up was not dictated by a fixed institutional protocol, raising the possibility of surveillance bias

Abstract

After bioprosthetic AVR, VKA exposure and porcine bioprostheses were independently associated with SVD. Antithrombotic strategies should consider the potential long-term adverse effects of VKA in the context of prosthesis material and patient characteristics. Prospective multicenter studies are needed to confirm these findings.

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Cite This Study

Dayanır et al. (Mon,) conducted a cohort in Bioprosthetic aortic valve replacement (n=123). Vitamin K antagonist (VKA) vs. Non-VKA (exposure <3 months) was evaluated on VARC-3-defined structural valve deterioration (SVD) (aHR 2.14, 95% CI 1.08-4.26, p=0.030). Postoperative vitamin K antagonist exposure significantly increased the risk of structural valve deterioration (aHR 2.14) compared to non-users after bioprosthetic aortic valve replacement.

synapsesocial.com/papers/69ba42ee4e9516ffd37a3ac4 https://doi.org/https://doi.org/10.4274/tjtcs.2026.28879