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Transcatheter Bioprosthetic Aortic Valve Dysfunction: What We Know So Far
Fadi Sawaya1,2, Troels H Jørgensen1, Lars Søndergaard1
1The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Frontiers in Cardiovascular Medicine
|October 23, 2019
Summary
Transcatheter aortic valve replacement (TAVR) is expanding to lower-risk patients. Long-term bioprosthetic valve durability is crucial, prompting standardized definitions for valve dysfunction like structural valve deterioration (SVD).
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomaterials Science
Background:
- Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis (AS), particularly in high-risk surgical candidates.
- Recent trials show TAVR efficacy in intermediate and low-risk patients, necessitating evaluation of long-term bioprosthetic valve durability.
- Standardized criteria for structural valve deterioration (SVD) and valve failure have been introduced to ensure uniform reporting in durability studies.
Purpose of the Study:
- To review the definition, incidence, and predictors of transcatheter bioprosthetic valve dysfunction.
- To discuss structural valve deterioration (SVD) and non-structural valve deterioration (NSVD).
- To examine valve thrombosis and endocarditis as causes of bioprosthetic valve dysfunction.
Main Methods:
- Review of recent clinical trials and guidelines.
- Analysis of standardized criteria for defining bioprosthetic valve failure.
- Synthesis of data on incidence and predictors of valve dysfunction.
Main Results:
- TAVR is increasingly used in lower-risk populations, highlighting the importance of long-term valve performance.
- Standardized definitions of SVD and valve failure are essential for comparing outcomes across studies.
- Valve dysfunction encompasses SVD, NSVD, thrombosis, and endocarditis, each with distinct characteristics and implications.
Conclusions:
- Long-term durability of TAVR bioprosthetic valves is a critical consideration as indications expand.
- Uniform definitions of valve deterioration are necessary for reliable assessment of bioprosthetic valve performance.
- Understanding the incidence and predictors of various forms of valve dysfunction is key to optimizing TAVR outcomes.
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