AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Elevated Lipoprotein(a) and Bioprosthetic Valve Outcomes: A Sytematic Review and Meta-Analysis
By Chiong E, Mahajan K, RODRIGUEZ MILAN R et al.
Background: Lipoprotein(a) [Lp(a)] is a causal risk factor for native calcific aortic stenosis, which shares pathobiology with bioprosthetic structural valve degeneration (SVD). Whether elevated Lp(a) predicts adverse outcomes after surgical or transcatheter bioprosthetic aortic valve replacement is uncertain. We performed a systematic review and meta-analysis comparing elevated serum Lp(a) measured by any validated assay with lower Lp(a) concentrations in patients with bioprosthetic aortic valve replacement. Hypothesis: Elevated Lp(a) is associated with higher rates of SVD, all-cause mortality, and subclinical leaflet thrombosis/hypoattenuated leaflet thickening (SLT/HALT) after bioprosthetic aortic valve replacement. Methods: PubMed, Embase, and Cochrane were searched through May 2026 for studies using prespecified elevated Lp(a) thresholds (predominantly ≥30 mg/dL) vs lower Lp(a) and (i) SVD, (ii) all-cause mortality, or (iii) SLT/HALT after bioprosthetic aortic valve replacement. Hazard ratios (HR) and odds ratios (OR) were pooled separately by outcome using inverse-variance random-effects models. Heterogeneity was assessed by I ² . Results: Six studies were included, encompassing 1,548 patients. Compared with lower Lp(a) concentrations, elevated serum Lp(a) was associated with a significantly higher risk of SVD (pooled HR 2.91; 95% CI 1.76-4.83; p<0.0001; I ² =7%; three studies; Figure 1) and all-cause mortality (pooled HR 1.53; 95% CI 1.13-2.08; p=0.006; I ² =16%; four studies; Figure 2). For SLT/HALT, there was no significant difference between groups (pooled OR 2.77; 95% CI 0.75-10.22; p=0.13; I ² =37%; two studies; Figure 3). Conclusions: Elevated Lp(a) was associated with significantly increased risks of SVD and all-cause mortality following bioprosthetic aortic valve replacement. Although no significant association was observed for SLT/HALT, the direction of effect was consistent with increased risk.