Noncalcific mechanisms of bioprosthetic structural valve degeneration

M Marro, AP Kossar, Y Xue, A Frasca… - Journal of the …, 2021 - Am Heart Assoc
M Marro, AP Kossar, Y Xue, A Frasca, RJ Levy, G Ferrari
Journal of the American Heart Association, 2021Am Heart Assoc
Bioprosthetic heart valves (BHVs) largely circumvent the need for long‐term anticoagulation
compared with mechanical valves but are increasingly susceptible to deterioration and
reduced durability with reoperation rates of≈ 10% and 30% at 10 and 15 years,
respectively. Structural valve degeneration is a common, unpreventable, and untreatable
consequence of BHV implantation and is frequently characterized by leaflet calcification.
However, 25% of BHV reoperations attributed to structural valve degeneration occur with …
Abstract
Bioprosthetic heart valves (BHVs) largely circumvent the need for long‐term anticoagulation compared with mechanical valves but are increasingly susceptible to deterioration and reduced durability with reoperation rates of ≈10% and 30% at 10 and 15 years, respectively. Structural valve degeneration is a common, unpreventable, and untreatable consequence of BHV implantation and is frequently characterized by leaflet calcification. However, 25% of BHV reoperations attributed to structural valve degeneration occur with minimal leaflet mineralization. This review discusses the noncalcific mechanisms of BHV structural valve degeneration, highlighting the putative roles and pathophysiological relationships between protein infiltration, glycation, oxidative and mechanical stress, and inflammation and the structural consequences for surgical and transcatheter BHVs.
Am Heart Assoc
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