Structural Bioprosthetic Aortic Valve Degeneration In Peripheral Artery Disease

Objective: The purpose of this study was to determine the impact of peripheral artery disease (PAD) on the development of bioprosthetic structural valve degeneration (SVD) in patients with severe aortic stenosis.Background: Bioprosthetic valves, both open surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), are subject to structural valve degeneration which impacts valve durability.The impact of peripheral artery disease on the viability of bioprosthetic structural valves is unclear.Methods: We screened patients over the age of 65 years who had undergone bioprosthetic aortic valve replacements (SAVRs or TAVRs) for degenerative severe aortic stenosis between 2007 and 2013 in our institution.We retrospectively analyzed clinical and echocardiographic data collected within three months post intervention and at least 3.5 years post intervention to determine the rates of predefined structural valve degeneration.Results: Eighty-two patients were included in the PAD cohort and 72 patients were included in the non-PAD cohort.The PAD cohort had higher rates of hypertension and coronary artery disease.The two groups had similar mean pressure gradient, dimensionless valve index, and effective orifice area at baseline post-intervention and at follow-up.At follow-up, there was a statistically significant difference in the rates of clinically relevant SVD in the PAD patients versus non-PAD patients [6 (7.3%) vs. 0 (0.0%), p = 0.03].Conclusion: Our study suggests a greater prevalence of SVD in patients with PAD.Future confirmatory studies are needed to explore the impact of PAD and related co-morbidities on valve durability.