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Tissue Valve Degeneration and Mechanical Valve Failure

  • Andrew C. W. Baldwin
  • George TolisJrEmail author
Valvular Heart Disease (J Dal-Bianco, Section Editor)
  • 5 Downloads
Part of the following topical collections:
  1. Topical Collection on Valvular Heart Disease

Abstract

Purpose of review

The management of valvular heart disease has been dramatically influenced by recent evolutions in biomedical technology and surgical practice. With an aging population worldwide and accompanying increase in the prevalence of surgical valve disease, an understanding of prosthetic valve behavior and durability is essential for proper patient selection and management. This report offers an overview of the definitions, mechanisms, management, and clinical impact of structural valve degeneration and failure.

Recent findings

Published literature has employed variable definitions and outcome measures, complicating our understanding of bioprosthetic valve behavior and function. The pathophysiology leading to structural valve degeneration is multifactorial and involves mechanical, hematologic, and immunologic elements. Technological advancements have resulted in improved valve performance and new strategies to mitigate the risks of degeneration.

Summary

While mechanical valves have demonstrated negligible durability concerns, the benefits of bioprosthetic valves must be weighed against their potential for structural degeneration and subsequent reintervention. Valve selection should involve patient-specific deliberation, and guidelines have been established to help guide risk reduction strategies. Surgical valve replacement remains the standard of care for prosthetic valve failure, but emerging technology offers the potential to slow the development of structural degeneration and transcatheter valve-in-valve options are being increasingly explored.

Keywords

Valvular heart disease  Mechanical heart valves  Bioprosthetic heart valves  Valvular degeneration  Calcification 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwofl C, Levang OW, et al. A prospective survey of patients with valvular heart disease in europe: the euro heart survey on valvular heart disease. Eur Heart J. 2003;24(13):1231–43.CrossRefGoogle Scholar
  2. 2.
    Nkomo VT, Gardin JM, Dkelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart disease: a population-based study. Lancet. 2006;368(9540):1005–11.CrossRefGoogle Scholar
  3. 3.
    Van Geldorp MW, Heuvelman HJ, Kappetein AP, Busschbach JJ, Takkenberg JJ, Bogers AJ. The effect of aortic valve replacement on quality of life in symptomatic patients with severe aortic stenosis. Neth Hear J. 2013;21(1):28–35.CrossRefGoogle Scholar
  4. 4.
    Isaacs AJ, Shuhaiber J, Salemi A, Isom OW, Sedrakyan A. National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements. J Thorac Cardiovasc Surg. 2015;149(5):1262–9.CrossRefGoogle Scholar
  5. 5.
    Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blakstone EH, Grunkemeier GL, et al. Councils of the American Association for Thoracic Surgery; Society of Thoracic Surgeons; European Association for Cardio-Thoracic Surgery; Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg. 2008;135:732–8.CrossRefGoogle Scholar
  6. 6.
    Swanson JS, Starr A. The ball valve experience over three decades. Ann Thorac Surg. 1989;48:S51–2.CrossRefGoogle Scholar
  7. 7.
    Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000;36(4):1152–8.CrossRefGoogle Scholar
  8. 8.
    Toole JM, Stroud MR, Kratz JM, Crumbley AJ, Bradley SM, Crawford FA, et al. Twenty-five year experience with the St. Jude medical mechanical valve prosthesis. Ann Thorac Surg. 2010;89:1402–9.CrossRefGoogle Scholar
  9. 9.
    Harris C, Croce B, Cao C. Tissue and mechanical heart valves. Ann Cardiothorac Surg. 2015;4(4):399.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Edmunds LH, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. J Thorac Cardiovasc Surg. 1996;112:708–11.CrossRefGoogle Scholar
  11. 11.
    Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, et al. Recommendation for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014.CrossRefGoogle Scholar
  12. 12.••
    Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, et al. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2017;52:408–17. Recent and thorough European consortium consensus statement on prosthetic valve evaluation.Google Scholar
  13. 13.••
    Dvir D, Bourguignon T, Otto CM, Hahn RT, Rosenhek R, Webb JG, et al. Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation. 2018;137:388–99. International consortium proposal for standardization of definitions for valvular degeneration and recommendations for follow-up protocols in an effort to improve the quality of data analysis and clinical decision-making for patients with bioprosthetic valves.Google Scholar
  14. 14.
    Forcillo J, Pellerin M, Perrault LP, Cartier R, Bouchard D, Demers P, et al. Carpentier-Edwards pericardial valve in the aortic position: 25-years experience. Ann Thorac Surg. 2013;96:486–93.CrossRefGoogle Scholar
  15. 15.
    Bourguignon T, Bouquiaux-Stablo AL, Canolfi P, Mirza A, Loardi C, May MA, et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Ann Thorac Surg. 2015;99:831–7.CrossRefGoogle Scholar
  16. 16.
    Senage T, Le Tourneau T, Foucher Y, Pattier S, Cueff C, Michel M, et al. Early structural valve deterioration of mitroflow aortic bioprosthesis: mode, incidence, and impact on outcome in a large cohort of patients. Circulation. 2014;130(23):2012–20.CrossRefGoogle Scholar
  17. 17.
    Saleeb SF, Newburger JW, Geva T, Baird CW, Gauvreau K, Padera RF, et al. Accelerated degeneration of a bovine pericardial bioprosthetic aortic valve in children and young adults. Circulation. 2014;130:51–60.CrossRefGoogle Scholar
  18. 18.••
    De Paulis R, D’Aleo S, Bellisario A, Salica A, Weltert LP, Scaffa R, et al. The fate of small-size pericardial heart valve prostheses in an older patient population. J Thorac Cardiovasc Surg. 2017;153:31–9. Single center large volume report of early-onset structural valve degeneration for 19mm and 21mm Mitroflow valves leading to widespread discontinuation of their use.Google Scholar
  19. 19.
    Gunn JM, Malmberg M, Vahasilta T, Lahti AL, Kuttila KT. Thirty-year results after implantation of the Bjork-Shiley convexo-concave heart valve prosthesis. Ann Thorac Surg. 2014;97:552–6.CrossRefGoogle Scholar
  20. 20.
    Starr A, Grunkemeier GL. Durability of the Starr-Edwards heart valve: early decisions led to successful results. Tex Heart Inst J. 2016;43(1):2–3.CrossRefGoogle Scholar
  21. 21.
    Tillquist MN, Maddox TM. Cardiac crossroads: deciding between mechanical or bioprosthetic heart valve replacement. Patient Prefer Adherence. 2011;5:91–9.CrossRefGoogle Scholar
  22. 22.
    Thubrikar MJ, Deck JD, Aouad J, Nolan SP. Role of mechanical stress in calcification of aortic bioprosthetic valves. J Thorac Cardiovasc Surg. 1983;86:115–25.PubMedGoogle Scholar
  23. 23.
    Vesely I, Barber JE, Ratliff NB. Tissue damage and calcification may be independent mechanisms of bioprosthetic heart valve failure. J Heart Valve Dis. 2001;10(4):471–7.PubMedGoogle Scholar
  24. 24.
    Chen W, Schoen FJ, Levy RJ. Mechanism of efficacy of 2-amino oleic acid for inhibition of calcification of glutaraldehyde-penetrated porcine bioprosthetic heart valves. Circulation. 1994;90:323–9.CrossRefGoogle Scholar
  25. 25.
    Schoen FJ, Tsao JW, Levy RJ. Calcification of bovine pericardium used in cardiac valve bioprostheses. Implications for the mechanisms of bioprosthetic tissue mineralization. Am J Pathol. 1986;123:134–45.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Manji RA, Zhu LF, Nijjar NK, Rayner DC, Korbutt GS, Churchill TA, et al. Glutaraldehyde-fixed bioprosthetic heart valve conduits calcify and fail from xenograft rejection. Circulation. 2006;114:318–27.CrossRefGoogle Scholar
  27. 27.
    Rahimtoola SH. Choice of prosthetic heart valve in adults: an update. J Am Coll Cardiol. 2010;55:2413–26.CrossRefGoogle Scholar
  28. 28.
    Rodriguez-Gabella T, Voisine P, Puri R, Pibarot P, Rodes-Cabau J. Aortic bioprosthetic valve durability: incidence, mechanisms, predictors, and management of surgical and transcatheter valve degeneration. J Am Coll Cardiol. 2017;70:1013–28.CrossRefGoogle Scholar
  29. 29.••
    Cote N, Pibarot P, Clavel MA. Incidence, risk factors, clinical impact, and management of bioprosthesis structural valve degeneration. Curr Opin Cardiol. 2017;32:123–9. Comprehensive review of the risk factors for bioprosthetic valve degeneration including discussion of immunologic and inflammatory mechanisms.Google Scholar
  30. 30.
    Le Tourneau T, Marechaux S, Vicentelli A, Ennezat PV, Modine T, Polge AS, et al. Cardiovascular risk factors as predictors of early and late survival after bioprosthetic valve replacement for aortic stenosis. J Heart Valve Dis. 2007;16:483–8.PubMedGoogle Scholar
  31. 31.
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–48.CrossRefGoogle Scholar
  32. 32.
    Williams ML, Bavaria JE, Acker MA, Desai ND, Vallabhajosyula P, Hargrove WC, et al. Valve Selection in end-stage renal disease: should it always be biological? Ann Thorac Surg. 2016;1102:1531–5.CrossRefGoogle Scholar
  33. 33.
    McClure RS, Narayanasamy N, Wiegerinck E, Lipsitz S, Maloney A, Byrne JG, et al. Late outcomes for aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: up to 17-year follow-up in 1000 patients. Ann Thorac Surg. 2010;89(5):1410–6.CrossRefGoogle Scholar
  34. 34.••
    Foroutan F, Guyatt GH, O’Brien K, Bain E, Stein M, Bhagra S, et al. Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies. BMJ. 2016;28:354. Metanalysis review of published outcomes for bioprosthetic aortic valve replacement demonstrating a low incidence of structural degeneration at 10 years with subsequent escalation of adverse events in later follow-up.Google Scholar
  35. 35.
    Jones JM, O’Kane H, Gladstone DJ, Sarsam MA, Campalani G, MacGowan SW, et al. Repeat heart valve surgery: risk factors for operative mortality. J Thorac Cardiovasc Surg. 2001;122:913–8.CrossRefGoogle Scholar
  36. 36.
    Maganti M, Rao V, Armstrong S, Feindel CM, Scully HE, David TE. Redo Valvular Surgery in Elderly Patients. Ann Throac Surg. 2009;87:521–5.CrossRefGoogle Scholar
  37. 37.
    Leontyev S, Borger MA, Davierwala P, Walther T, Lehmann S, Kempfert J, et al. Redo Aortic Valve Surgery: Early and Late Outcomes. Ann Thorac Surg. 2011;91:1120–6.CrossRefGoogle Scholar
  38. 38.••
    Mehaffey HJ, Hawkins RB, Schubert S, Fonner C, Yarboro LT, Quader M, et al. Contemporary outcomes in reoperative mitral valve surgery. Heart. 2018;104:652–6. Recent large volume STS database outcomes review comparing primary mitral valve surgical risk with redo intervention.Google Scholar
  39. 39.
    Silaschi M, Wendler O, Seiffert M, Castro L, Lubos E, Schirmer J, et al. Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses. Interact Cardiovasc Thorac Surg. 2017;24:63–70.CrossRefGoogle Scholar
  40. 40.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College Of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2017;70(2):252–89.CrossRefGoogle Scholar
  41. 41.••
    Goldstone AB, Chiu P, Baiocchi M, Lingala B, Patrick WL, Fischbein MP, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med. 2017;377:1847–57. NIH-sponsored retrospective population-based study suggesting a mortality benefit with the use of mechanical valves until age 70 in the mitral position and age 55 for aortic valves.Google Scholar
  42. 42.
    Fiedler AG, Tolis G. Surgical Treatment of valvular heart disease: overview of mechanical and tissue prostheses, advantages, disadvantages, and implications for clinical use. Curr Treat Options Cardio Med. 2018;20(1):7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Cardiac SurgeryMassachusetts General HospitalBostonUSA

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