Oxidative Stress in Structural Valve Deterioration: A Longitudinal Clinical Study

Figures

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  Figure 1. (a) Study protocol diagram (SVD—structural valve deterioration). See text for details. (b) Chart showing the number of patients recruited for the assessment of oxidative stress in the different phases and study groups (BHV, bioprosthetic heart valve).

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  Figure 2. (a) Total antioxidant capacity (TAC, in mm), (b) malondialdehyde (MDA, in µm), and (c) nitrotyrosine (NT, in nm) values in Phase B1 patients with implanted aortic biological heart valves (BHVs) at different time points (baseline and 1, 6, 12, and 24 months after implantation). Patients undergoing coronary artery bypass (CABG) surgery and aortic valve replacement with a mechanical heart valve (MHV) served as the controls. The numbers within the figures represent the p-values, and the numbers at the bottom of the figures represent the number of assessed patients. Multiple comparison adjustments were performed with Dunnett’s and Tukey–Kramer’s procedures.

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  Figure 3. (a) Total antioxidant capacity (TAC, in mm), (b) malondialdehyde (MDA, in µm), and (c) nitrotyrosine (NT, in nm) values in Phase B1 patients with aortic biological heart valves (BHVs) only made of pericardial tissues implanted surgically (AVR) and by transcatheter aortic valve implantation (TAVI) at different time points (baseline and 1, 6, 12, and 24 months after implantation). The numbers within the figures represent the p-values, and the numbers at the bottom of the figures represent the number of assessed patients. Multiple comparison adjustments were performed with Dunnett’s and Tukey–Kramer’s procedures.

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  Figure 4. (a) Total antioxidant capacity (TAC, in mm), (b) malondialdehyde (MDA, in µm), and (c) nitrotyrosine (NT, in nm) values in Phase B1 patients with implanted aortic biological prostheses at different time points according to the observed increment (Δ) in the mean aortic prosthesis gradient (Δ < 10 mmHg—without incipient SVD, and Δ ≥ 10 mmHg—with incipient SVD) between the 6- and the 12- to 24-month follow-ups. Therefore, each patient acted as his or her own control (e.g., paired results). The numbers within the figures represent the p-values, and the numbers at the bottom of the figures represent the number of assessed patients. Multiple comparison adjustments were performed with Dunnett’s and Tukey–Kramer’s procedures.

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  Figure 5. (a) Total antioxidant capacity (TAC, in mm), (b) malondialdehyde (MDA, in µm), and (c) nitrotyrosine (NT, in nm) values in patients diagnosed with structural valve disease (SVD—Phase A) and in Phase B2 patients with implanted aortic biological heart valves (BHV) at the time of recruitment (>48 months after surgery). Patients undergoing coronary artery bypass (CABG) surgery and aortic valve replacement with a mechanical heart valve (MHV), also recruited >48 months after surgery, served as the controls. The numbers within the figures represent the p-values, and the numbers at the bottom of the figures represent the number of assessed patients. Multiple comparison adjustments were performed with Dunnett’s and Tukey–Kramer’s procedures.

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  Figure 6. (a,d) Total antioxidant capacity (TAC, in mm), (b,e) malondialdehyde (MDA, in µm), and (c,f) nitrotyrosine (NT, in nm) values in Phase B2 patients with all types of implanted aortic biological heart valves (BHVs) and in Phase B2 patients with implanted bovine pericardium and porcine aortic BHVs, respectively, at the time of recruitment (>48 months after surgery) and after 12–24 months of follow-up (>60–72 months after aortic valve implantation). The numbers within the figures represent the p-values, and the numbers at the bottom of the figures represent the number of assessed patients. Multiple comparison adjustments were performed with Dunnett’s and Tukey–Kramer’s procedures.

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  Figure 7. (a) Total antioxidant capacity (TAC, in mm), (b) malondialdehyde (MDA, in µm), and (c) nitrotyrosine (NT, in nm) values in Phase A patients (established SVD) and in Phase B2 patients with implanted aortic biological heart valves (BHV) according to the observed increment (Δ) in mean aortic prosthesis gradient (Δ < 10 mmHg—without incipient SVD; Δ ≥ 10 mmHg—with incipient SVD) between the baseline (>48 months after aortic valve implantation) and 12–24 months of follow-up (>60–72 months after aortic valve implantation). Therefore, each patient acted as his or her own control (e.g., paired results). The numbers within the figures represent the p-values, and the numbers at the bottom of the figures represent the number of assessed patients. Multiple comparison adjustments were performed with Dunnett’s and Tukey–Kramer’s procedures.

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  Figure 8. (a) Total antioxidant capacity (TAC, in mm), (b) malondialdehyde (MDA, in µm), and (c) nitrotyrosine (NT, in nm) values in Phase B2 patients with bovine pericardium aortic biological heart valves according to the type of framework (stented, stentless, TAVI) at the time of recruitment (>48 months after aortic valve replacement) and after 12- to 24-month follow-up (>60–72 months after aortic valve implantation). The numbers within the figures represent the p-values, and the numbers at the bottom of the figures represent the number of assessed patients. Multiple comparison adjustments were performed with Dunnett’s and Tukey–Kramer’s procedures.