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We hypothesize that calcium supplementation (CaS) use may hasten the degeneration of bioprosthetic valves. The aim of this study was to study the impact of CaS use on aortic or mitral valve bioprostheses.
Patients who received aortic and mitral bioprosthesis from 11/1979 to 12/2010 at our institution were retrospectively studied. Primary outcomes were the change in mean valvular gradients as measured by echocardiography and freedom from re–do valve replacement. A linear mixed effects model was used to examine the association between CaS use and change in valve gradient after adjusting for potential confounders. Multiple logistic regression was used to develop a propensity score to adjust for patient use of CaS. Multivariable Cox proportional hazard modeling (CPH) was used to examine the association between CaS use and freedom from valve replacement after adjusting for potential confounders and this propensity score.
The study included 949 patients with a total of 1035 aortic bioprosthetic valve implantations [343 (33%) female, mean age of 67.4 years (SD=10.9 years), 105 (10%) on CaS] and 231 patients with a total of 262 mitral bioprosthetic valve implantations [157 (60%) female, mean age of 68.2 (SD=11.8 years), 32 (10%) on CaS]. A total of 6460 follow up echocardiograms were available for aortic valve bioprosthesis with a median data collection time for 4 years and 1595 echocardiograms for mitral bioprosthesis for a median time of 3.1 years. Multivariable analyses showed an association between patient CaS use and valvular gradient progression with mitral (p=0.028) but not aortic (p=0.67) valves. CPH risk–adjusted models revealed that need for repeat valve replacement was associated with calcium use both with aortic [p<.0001, hazard ratio 2.73 (95%CI 1.76–4.24)] and mitral [p= 0.025; hazard ratio 2.38 (95%CI 1.12–5.07)] bioprostheses.
In this retrospective analysis of patients with aortic and mitral bioprosthetic valves, the use of calcium supplementation is associated with higher rates of repeat valve replacements. Calcium supplementation worsens mean valve gradients over time with mitral but not aortic valves.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Valvular Heart Disease: Clinical VI – Prosthetic Valve
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1241–80
- 2013 American College of Cardiology Foundation