Incidence, risk factors, clinical impact, and management of bioprosthesis structural valve degeneration

Structural valve deterioration is the major cause of bioprosthesis failure and is increasing over time. We present an overview of incidence, mechanisms, predictors, clinical impact, and management of bioprosthetic valve structural degeneration.

Early degeneration caused by calcification and destruction of connective tissue of the prosthesis is controlled by multiple mechanisms, from mechanical stress to infiltration of lipids and inflammatory cells, and activation of the immune system. Despite major improvements in valve design and surgical procedures, the pathology is still the main limiting factor to the long-term durability. Appropriate selection of the model and size of bioprosthesis as well as proper medical management and follow-up after valve replacement are essential for optimal prevention, detection, and management of structural valve deterioration. Currently, redo open-heart surgery is the most frequently used approach to treat structural valve deterioration. The transcatheter valve-in-valve procedure, however, is a valuable alternative to surgery for high-risk patients.

Structural valve deterioration is responsible for significant morbidity and mortality after valve replacement. This multifactorial pathology is the main cause of valve re-intervention during follow-up. Although redo surgery is still the most frequently used intervention to treat valve structural failure, the transcatheter valve-in-valve procedure is rapidly expanding.