Limitation
Beside the known limitations inherent to the retrospective nature of
this study we acknowledge some other limitations. For this study, we
used the WHO definition for MetS, and perhaps the use of different
definitions such as the NCEP/ATP 3 or IDF could have potentially led to
different results. For the obesity, the latter two definitions refer
more specifically to waist circumferences rather than
BMI>30 kg\m2, pointing the
focus to the visceral adiposity(16). Microalbuminuria, an adjunctive
criterion for the WHO definition of MetS, was not recoded in our
dataset.
Long term follow-up was not carried out; hence we could not evaluate the
impact of MetS at distance. In fact, an important aspect of MetS is the
tendency to accelerated development of pressure gradient in the
bioprosthetic valve(22). Nevertheless, the progression of aortic
bioprosthetic valve gradient and stenosis was not investigated.