Standardized Definition of Structural Valve Degeneration for Surgical and Transcatheter Bioprosthetic Aortic Valves

Dvir, Danny; Bourguignon, Thierry; Otto, Catherine M.; Hahn, Rebecca T.; Rosenhek, Raphaël; Webb, John G.; Treede, Hendrik; Sarano, Maurice E.; Feldman, Ted; Wijeysundera, Harindra C.; Topilsky, Yan; Aupart, Michel; Reardon, Michael J.; Mackensen, G. Burkhard; Szeto, Wilson Y.; Kornowski, Ran; Gammie, James S.; Yoganathan, Ajit P.; Arbel, Yaron; Borger, Michael A.; Simonato, Matheus; Reisman, Mark; Makkar, Raj; Abizaid, Alexandre; McCabe, James M.; Dahle, Gry; Aldea, Gabriel S.; Leipsic, Jonathon; Pîbarot, Philippe; Moat, Neil; Mack, Michael J.; Kappetein, Arie Pieter; Leon, Martin B.

doi:10.1161/circulationaha.117.030729

Cited by 370 publications

(285 citation statements)

References 64 publications

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“…An increase in transprosthetic velocity and gradients with concomitant increase in valve EOA and DVI is actually related to an increase in flow during follow-up and should not be mistaken for a HVD. Stage 3 consists in SVD with severe HVD characterised by: (1) an increase in mean transprosthetic gradient ≥20 mm Hg since SAVR or TAVI with concomitant marked decrease in valve EOA and DVI and/or (2) new onset or worsening of transprosthetic regurgitation by at least two grades with final grade of severe regurgitation.Classification terminology proposed by: *Dvir et al 12 and †Capodanno et al 11

‡The most important criteria to define hemodynamic HVD is a significant increase in mean transprosthetic gradient with concomitant decrease in valve effective orifice area and Doppler velocity index; and/or a new onset or a worsening of transprosthetic valve regurgitation.

§This criteria is corroborative but should not be used in isolation to define HVD.

AVR, aortic valve replacement; HVD, hemodynamic valve deterioration; LV, left ventricle; MDCT, multidetector CT; SVD, structural valve deterioration; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography.

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Section: Definition Of Bioprosthetic Valve Deteriorationmentioning

confidence: 99%

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Salaün

Clavel

Rodés‐Cabau

et al. 2018

Heart

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The main limitation of bioprosthetic valves is their limited durability, which exposes the patient to the risk of aortic valve reintervention. Transcatheter aortic valve implantation (TAVI) is considered a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with intermediate or high surgical risk. TAVI is now rapidly expanding towards the lower risk populations. Although the results of midterm durability of the transcatheter bioprostheses are encouraging, their long-term durability remains largely unknown. The objective of this review article is to present the definition, mechanisms, incidence, outcome and management of structural valve deterioration of aortic bioprostheses with specific emphasis on TAVI. The structural valve deterioration can be categorised into three stages: stage 1: morphological abnormalities (fibrocalcific remodelling and tear) of bioprosthesis valve leaflets without hemodynamic valve deterioration; stage 2: morphological abnormalities and moderate hemodynamic deterioration (increase in gradient and/or new onset of transvalvular regurgitation); and stage 3: morphological abnormalities and severe hemodynamic deterioration. Several specifics inherent to the TAVI including valve oversizing, manipulation, delivery, positioning and deployment may cause injuries to the valve leaflets and increase leaflet mechanical stress, which may limit the long-term durability of transcatheter bioprostheses. The selection of the type of aortic valve replacement and bioprosthesis should thus take into account the ratio between the demonstrated durability of the bioprostheses versus the life expectancy of the patient. Pending the publication of robust data on long-term durability of transcatheter bioprostheses, it appears reasonable to select SAVR with a bioprosthesis model that has well-established long-term durability in patients with low surgical risk and long life expectancy.

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§This criteria is corroborative but should not be used in isolation to define HVD.

…”

Section: Definition Of Bioprosthetic Valve Deteriorationmentioning

confidence: 99%

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Salaün

Clavel

Rodés‐Cabau

et al. 2018

Heart

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“…However, BHVs are intrinsically limited by degeneration of leaflet tissue matrix, a process named "Structural Valve Degeneration" (SVD). SVD, whose definition has only recently been standardized 3 , constitutes pathologic modification of valve leaflets ultimately compromising biomechanical function. BHV lifespans are limited by SVD 3,4 to an average between 10-15 years due to functional failure.…”

Section: Introductionmentioning

confidence: 99%

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Frasca

Xue

Kossar

et al. 2020

Preprint

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Background: Bioprosthetic heart valves (BHV) are widely used to treat heart valve disease but are fundamentally limited by structural valve degeneration (SVD). Non-calcific mechanisms of SVD entirely account for approximately 30% of SVD cases and contribute to calcific SVD but remain understudied. Glycation mechanisms have not been previously associated with SVD, despite being established as degenerative in collagenous native tissues. Objectives:To determine whether blood component infiltration-based glycation and concomitant human serum albumin (HSA) deposition contribute mechanistically to SVD.Methods: Immunohistochemistry (IHC) was used to identify advanced glycation end-products (AGEs) and serum albumin accumulation in 45 aortic valve BHV explanted due to SVD, glutaraldehyde-treated bovine pericardium (BP) incubated in vitro in glyoxal and HSA, and rat subcutaneous BP implants. Structural impacts of glycation-related mechanisms were evaluated by second harmonic generation (SHG) collagen imaging. Hydrodynamic effects of valve glycation and concomitant HSA exposure were studied with an ISO-5840-compliant pulse duplicator system using surgical grade BHV.Results: All 45 clinical explants and in vitro-incubated BP demonstrated accumulated AGE and HSA compared to un-implanted, un-exposed BHV. SHG revealed instigation of collagen malalignment similar to that in SVD explants by glycation and HSA infiltration. Rat subdermal explants also showed AGE and serum albumin accumulation. Pulse duplication demonstrated significantly reduced orifice area and increased pressure gradient and peak fluid velocity following glyoxal and HSA incubations. Conclusions:Glycation and concomitant HSA infiltration occur in clinical BHV and contribute to structural and functional degeneration of leaflet tissue, thus representing novel, interacting mechanisms of BHV SVD.

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“…While these devices obviate the need for long-term anticoagulation, the key disadvantage to their use is structural valve degeneration 2. Some devices have reported rates of freedom from reintervention over 95% at 10 years, but this number substantially drops to about 60% by 20 years follow-up 3 4.…”

Section: Introductionmentioning

confidence: 99%

“…Not all devices are this successful, with some demonstrating greater rates of failure earlier after implantation 5. The definitions of valve degeneration have been variable, with several studies using reintervention as the only marker of failure and others, more recent, considering echocardiographic parameters 2. International groups have attempted to standardise the field by publishing definitions featuring a stepwise process including echocardiographic changes and also the need for reoperation 2 6…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement in failed surgical valves

Simonato

Dvir

2019

Heart

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Aortic valve-in-valve is a less invasive alternative to surgical redo in the treatment of failed bioprosthetic valves. While only inoperable patients underwent the procedure before, operators currently offer it to those at lower risk and worldwide experience is in the thousands. Early mortality has diminished in recent analyses and improvements in symptoms and quality of life have been documented. Main considerations with aortic valve-in-valve include elevated postprocedural gradients, coronary obstruction and leaflet thrombosis. Risk factors for each of these adverse events have been described at length. Aortic valve-in-valve offers a safe and effective option in the management of failed bioprosthetic valves.

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Standardized Definition of Structural Valve Degeneration for Surgical and Transcatheter Bioprosthetic Aortic Valves

Cited by 370 publications

References 64 publications

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Transcatheter aortic valve replacement in failed surgical valves

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