Clin Res Cardiol (2025). DOI 10.1007/s00392-025-02737-x
1Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; 2Deutsches Herzzentrum München Klinik für Herz- und Gefäßchirurgie München, Deutschland
Background: The expanding use of transcatheter aortic valve implantation (TAVI) in low-risk and younger patients has increased concerns regarding the long-term durability of bioprosthetic valves. Lipoprotein(a) [Lp(a)] is an emerging cardiovascular risk factor implicated in the pathogenesis of native aortic stenosis, but its impact on bioprosthetic valve degeneration remains unclear.
Objective: To evaluate the association between Lp(a) levels and structural degeneration of aortic bioprosthetic valves in patients undergoing valve-in-valve (ViV) TAVI, in the largest retrospective cohort studied to date.
Methods: We retrospectively analyzed 389 patients with available Lp(a) measurements who underwent ViV TAVI for degenerated aortic bioprosthetic valves. The primary endpoint was time-to-reintervention, defined as the interval from initial aortic valve replacement (surgical or TAVI) to the ViV TAVI procedure. Patients were stratified by Lp(a) levels into low (<50 mg/dl) and high (≥50 mg/dl) groups. Associations between Lp(a) levels and time-to-reintervention were assessed using Kaplan-Meier survival analysis. Additionally, Pearson correlation analysis was performed to evaluate the linear relationship between Lp(a) levels and time-to-reintervention.
Results: Among the 389 patients, 239 had low and 152 had high Lp(a) levels. Baseline characteristics were comparable between groups. The median time from initial valve implantation to ViV TAVI did not differ significantly by Lp(a) group. Kaplan-Meier analysis demonstrated no significant association between elevated Lp(a) and time-to-reintervention (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.66–1.17; p = 0.3728). Pearson correlation showed no significant relationship between Lp(a) concentration and time-to-reintervention (r = 0.07, p = 0.1678).
Conclusions: In this large ViV TAVI cohort, elevated Lp(a) levels were not associated with accelerated structural degeneration of aortic bioprosthetic valves or earlier need for reintervention. These results suggest that, unlike in native aortic stenosis, Lp(a) does not play a significant role in bioprosthetic valve degeneration.