Valve durability has emerged as an important issue in the current era of aortic valve replacement. A review paper published August 14 in the Journal of the American College of Cardiology provides an overview of bioprosthetic valve durability, focusing on the definition, incidence, mechanisms, predictive factors and management of structural degeneration of aortic bioprostheses.

In this review, Tania Rodriguez-Gabella, MD, et al., discuss the available data on the durability of aortic bioprostheses; review the definitions, incidence, timing and mechanisms of structural valve degeneration (SVD); and evaluate the current treatment options for valve failure due to SVD.

Valve leaflet calcification has been recognized as the main reason for SVD, while patient characteristics such as younger age and larger body mass index, cardiovascular risk factors and variables pertaining to bioprosthetic valves are all factors associated with increased risk.

The authors point to a need for a universal definition of SVD using echocardiographic parameters that consider the changes in valve performance over time, as well as a need to standardize follow-up echocardiographic recommendations following transcatheter aortic valve replacement and surgical aortic valve replacement.

“The significant increase in the use of aortic bioprostheses in recent times will inevitably lead to rising numbers of patients diagnosed with SVD in the next decade,” the authors write. “This should stimulate further research efforts in the prevention and treatment of this entity, particularly if we embrace the possibility of treating younger patients with biological (instead of mechanical) valves.” 

Keywords: Bioprosthesis, Aortic Valve, Transcatheter Aortic Valve Replacement, Incidence, Follow-Up Studies, Body Mass Index, Cardiovascular Diseases, Risk Factors, Heart Valve Prosthesis, Calcinosis, Calcification, Physiologic

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