The Present and Future
JACC State-of-the-Art Review
Standardized Definitions for Bioprosthetic Valve Dysfunction Following Aortic or Mitral Valve Replacement: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2022.06.002Get rights and content
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Highlights

  • Both surgical and transcatheter aortic and mitral bioprosthetic valves have limited durability and are prone to structural valve deterioration.

  • Consideration only of valve-related reintervention or death underestimates the incidence of structural BVD.

  • Definition of structural BVD requires confirmation by imaging of permanent structural changes in the leaflets, struts, or stent and hemodynamic deterioration.

Abstract

Bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF) may be caused by structural or nonstructural valve dysfunction. Both surgical and transcatheter bioprosthetic valves have limited durability because of structural valve deterioration. The main objective of this summary of experts participating in a virtual workshop was to propose standardized definitions for nonstructural and structural BVD and BVF following aortic or mitral biological valve replacement with the goal of facilitating research reporting and implementation of these terms in clinical practice. Definitions of structural BVF, based on valve reintervention or death, underestimate the true incidence of BVF. However, definitions solely based on the presence of high transprosthetic gradient at a given echocardiogram during follow-up overestimate the incidence of structural BVD and BVF. Definitions of aortic or mitral structural BVD must therefore include the confirmation by imaging of permanent structural changes to the leaflets alongside evidence of deterioration in valve hemodynamic function at echocardiography follow-up.

Key Words

aortic valve replacement
bioprosthetic valve dysfunction (BVD)
bioprosthetic valve failure (BVF)
mitral valve replacement

Abbreviations and Acronyms

BVD
bioprosthetic valve dysfunction
BVF
bioprosthetic valve failure
DVI
Doppler velocity index
HALT
hypo-attenuated leaflet thickening
LV
left ventricle
PPM
prosthesis-patient mismatch
RLM
restricted leaflet motion
SAVR
surgical aortic valve replacement
TAVR
transcatheter aortic valve replacement

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Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

Philip Haines, MD, served as Guest Associate Editor for this paper. Athena Poppas, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

This paper reflects the views of the authors and does not necessarily represent the practices, policies, requirements, or recommendations of the U.S. Food and Drug Administration. The mention of commercial products, their sources, or their use in connection with material reported here is not to be construed as either an actual or implied endorsement of such products by the Department of Health and Human Services. Furthermore, the use of the word “required,” “must,” or “should” in the document is not intended to indicate a U.S. Food and Drug Administration requirement.

More details about the Heart Valve Collaboratory can be found at https://www.heartvalvecollaboratory.org/. This paper is a summary of a virtual workshop organized by the Heart Valve Collaboratory and held on October 1-2, 2021.