Cardiology Letters 2020, 29(1):44-49

Structural valve deterioration

Vranka I^{1, 2}, Fridrich V², Gonçalvesová E¹

¹ Kardiologická klinika, Lekárská fakulta Univerzita Komenského a Národného ústav srdcových a cievnych chorôb, a. s., Bratislava

² Oddelenie intervenčnej kardiológie, Národný ústav srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika

Transcatheter aortic valve implantation (TAVI) has initiated interest about the degenerative process of bioprosthesis. Bioprostheses are used in preference over mechanical valves in cardiosurgery and are exclusively used in TAVI procedure. Extending the use of TAVI in low risk group patients (more than 80% of all severe aortic stenosis) and TAVI as a treatment option in younger patients with longer life expectancy increases the importance of longterm durability and reliable function of bioprostheses. Although follow-up data are only medium term, transcatheter bioprotheses does not look worse than surgically implanted. Bioprostheses valve degeneration will become a major cause of cardiovascular morbididy and health care burden over the coming decades. Structural bioprostheses damage is a natural process and is due to the interaction between the patient and the new valve. Until the bioprosthesis fails, degeneration is mostly clinically silent. With the shift of TAVI indication to low-risk and therefore to younger patients, it is important to monitor patients carefully after the implantation of the bioprosthesis using appropriate imaging methods. The principle is a standardised post-implantation reference echocardiographic examination and subsequent regular echocardiographic follow-up with quantification of the set comparable parameters (mean gradient on bioprosthesis, effective orifice area, vena contracta width, regurgitation volume). Detection of patients with signs of early prosthesis degeneration is important for their further safe and effective management, with early prediction of failure of the prosthesis. Reintervention is indicated in the stage of severe structural damage in symptomatic patients, or in asymptomatic patients at low operational risk respectively. Cardiac surgery is considered conventional, but catheter reintervention, valve-to-valve, may be considered in patients at risk.

Keywords: aortic stenosis; bioprosthesis; structural valve deterioration; bioprosthesis failure; TAVI

Published: January 1, 2020  Show citation