Current definitions of hemodynamic structural valve deterioration after bioprosthetic aortic valve replacement lack consistencyCentral MessagePerspective
Bart J.J. Velders, MD,
Michiel D. Vriesendorp, MD, PhD,
Federico M. Asch, MD,
Michael J. Reardon, MD,
Francois Dagenais, MD,
Michael G. Moront, MD,
Joseph F. Sabik III, MD,
Rolf H.H. Groenwold, MD, PhD,
Robert J.M. Klautz, MD, PhD
Affiliations
Bart J.J. Velders, MD
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Address for Reprints: Bart J. J. Velders, MD, Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Michiel D. Vriesendorp, MD, PhD
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
Federico M. Asch, MD
Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC; Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex; Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada; Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio; Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
Michael J. Reardon, MD
Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC; Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
Francois Dagenais, MD
Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC; Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
Michael G. Moront, MD
Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC; Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
Joseph F. Sabik III, MD
Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC; Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
Rolf H.H. Groenwold, MD, PhD
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
Robert J.M. Klautz, MD, PhD
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
Objective: New echocardiographic definitions have been proposed for hemodynamic structural valve deterioration. We aimed to study their consistency in classifying structural valve deterioration after surgical aortic valve replacement. Methods: Data were used of patients undergoing surgical aortic valve replacement in a multicenter, prospective cohort study with a 5-year follow-up. All patients received the same stented bioprosthesis. Echocardiographic parameters were assessed by an independent core laboratory. Moderate or greater stenotic hemodynamic structural valve deterioration was defined according to Capodanno and colleagues, Dvir and colleagues, and the Valve Academic Research Consortium 3; regurgitation data were not considered in this analysis. Consistency was quantified on the basis of structural valve deterioration classification at subsequent time points. Results: A total of 1118 patients received implants. Patients’ mean age was 70 years, and 75% were male. Hemodynamic structural valve deterioration at any visit was present in 51 patients (4.6%), 32 patients (2.9%), and 34 patients (3.0%) according to Capodanno, Dvir, and Valve Academic Research Consortium 3. A total of 1064 patients (95%) were never labeled with structural valve deterioration by any definition. After the first classification with structural valve deterioration, 59%, 59%, and 65% had no subsequent structural valve deterioration classification according to Capodanno, Dvir, and Valve Academic Research Consortium 3, respectively. Conclusions: The current definitions of hemodynamic structural valve deterioration are strong negative predictors but inconsistent positive discriminators for the detection of stenotic hemodynamic structural valve deterioration. Although the diagnosis of structural valve deterioration may be categorical, echocardiographic indices lack this degree of precision in the first 5 years after surgical aortic valve replacement. The inconsistency of current structural valve deterioration definitions impedes the detection of true valve degeneration, which challenges the clinical usefulness of these definitions.
