Categories of Bioprosthetic Valve Dysfunction |
Structural valve deterioration Intrinsic permanent changes to the prosthetic valve, including leaflet tear, disruption, flail leaflet, leaflet fibrosis and/or calcification. See Online Table 2 for definitions of stages. |
Non-structural valve dysfunction Any abnormality, not intrinsic to the prosthetic valve, resulting in valve dysfunction. Examples include residual intra- or para-prosthetic aortic regurgitation; leaflet entrapment by pannus, tissue, or suture; inappropriate positioning or sizing; dilatation of the aortic root after stentless prostheses or aortic valve sparing operations; prosthesis-patient mismatch; and embolization. |
Valve thrombosis Subclinical: Imaging findings of hypo-attenuated (CT) or hypo-echogenic (echocardiography) leaflet thickening and/or reduced leaflet motion with absent of mild hemodynamic changes and no symptoms/sequelae. Clinically significant: 1) Clinical sequelae of thrombo-embolic event or of worsening bioprosthetic valve stenosis or regurgitation and hemodynamic valve deterioration Stage 2 or 3 (See Online Table 2). 2) In the absence of clinical sequelae, both hemodynamic valve deterioration Stage 2 or 3 and confirmatory imaging (leaflet thickening and/or reduced leaflet motion). |
Valve endocarditis Meeting at least one of the following criteria: (1) Fulfillment of the Duke endocarditis criteria (2) Evidence of abscess, pus, or vegetation confirmed as secondary to infection by histological or microbiological studies during re-operation; (3) Evidence of abscess, pus, or vegetation confirmed on autopsy. |
Clinical Presentation |
Subclinical Stage 1: Any bioprosthetic valve dysfunction associated with absent or mild hemodynamic changes, AND absent symptoms or sequelae. Bioprosthetic valve failure Stage 1: Any significant bioprosthetic valve dysfunction with clinically expressive criteria (new-onset or worsening symptoms, LV dilation/hypertrophy/dysfunction, or pulmonary hypertension) OR Stage 3 hemodynamic valve deterioration related to permanent changes to the prosthetic valve. Stage 2: Aortic valve reoperation or reintervention. Stage 3: Valve-related death.† |