Tissue Valve Degeneration and Mechanical Valve Failure
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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.
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.
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.
KeywordsValvular heart disease Mechanical heart valves Bioprosthetic heart valves Valvular degeneration Calcification
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
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