A systematic review on durability and structural valve deterioration in TAVR and surgical AVR

Abstract

Mechanical valves and bioprosthetic heart valves are widely used for aortic valve replacement (AVR). Mechanical valves are associated with risk of bleeding because of oral anticoagulation, while the durability and structural valve deterioration (SVD) represent the main limitation of the bioprosthetic heart valves. The implantation of bioprosthetic heart valves is increasing precipitously due aging population, and the widespread use of transcatheter aortic valve replacement (TAVR). TAVR has become the standard treatment for intermediate or high surgical risk patients and a reasonable alternative to surgery for low risk patients with symptomatic severe aortic stenosis. Moreover, TAVR is increasingly being used for younger and lower-risk patients with longer life expectancy; therefore it is important to ensure the valve durability for long-term transcatheter aortic valves. Although the results of mid-term durability of the transcatheter heart valves are encouraging, their long-term durability remains largely unknown. This review summarises the definitions, mechanisms, risk factors and assessment of SVD; overviews available data on surgical bioprosthetic and transcatheter heart valves durability.

Keywords:

• Bioprosthetic heart valves
• durability
• structural valve deterioration
• transcatheter aortic valve implantation
• transcatheter heart valves

Acknowledgements

The authors thank Prof. Dr. Francesco Maisano, Prof. Dr. Maurizio Taramasso, Prof. Dr. Carlos Mestres, Assoc. Prof. Dr. Martin Andreas, other CAS - Aortic Valve Structural Interventions faculty and participants for enabling positive research and academic environment during writing process of this manuscript.

Disclosures statement

The authors have no relationships relevant to the contents of this paper to disclose.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.