Transcatheter aortic valve degeneration: a combined clinical and translational perspective

As transcatheter aortic valve implantation (TAVI) is increasingly used in younger and lower-risk patients, long-term valve durability has become a growing concern. Bioprosthetic valve degeneration (BVD) is multifactorial, encompassing calcific and non-calcific structural deterioration, non-structural deterioration, valve thrombosis and procedural or device-related factors. This review aims to provide a look across the spectrum of understanding BVD, presenting insights from fundamental and translational science through to the clinic to give a comprehensive overview of the mechanisms underlying BVD in TAVI valves. This review highlights the pivotal role of multimodality imaging in detection, classification and monitoring of degeneration and discusses the emerging pharmacological and engineering innovations aimed at preventing degeneration. Finally, reintervention strategies, including redo-TAV and surgical explantation, are explored with an emphasis on CT-based planning and bench-testing insights that have enhanced our understanding of BVD and inform ongoing procedural refinement. These perspectives support a proactive and tailored approach to managing transcatheter aortic valve degeneration across the patient's lifetime.