Early failure of aortic bioprostheses: what are the mechanisms?

Abstract

The purpose of this study is to review the contemporary evidence surrounding aortic bioprosthetic valve deterioration, with a focus on early failure of surgically implanted valves. Structural valve deterioration (SVD) remains the most frequent cause of premature bioprosthetic aortic valve failure. However, recent evidence suggests that SVD represents a spectrum, and that clinically silent hemodynamic valve deterioration frequently precedes and predisposes to overt SVD. Hemodynamic valve deterioration is defined as an increase in mean transprosthetic gradient and/or worsening transprosthetic regurgitation on echocardiography. Novel evidence suggests that a dysmetabolic profile may predispose to this phenomenon. Furthermore, subclinical leaflet thrombosis is increasingly recognized as a potential cause of hemodynamic deterioration of bioprosthetic valves. Collectively, these findings highlight the importance of systematic and regular imaging surveillance following bioprosthetic aortic valve replacement. Early failure of bioprosthetic aortic valves is a complex and multifactorial phenomenon. Further studies are needed to determine the optimal timing and imaging modality for surveillance following bioprosthetic aortic valve replacement, and to establish strategies to prevent and treat aortic bioprosthetic failure.