Bismee Nadera N, Javadi Niloofar, Khedr Ahmed, Omar Fatma, Awad Kamal, Abbas Mohammed Tiseer, Scalia Isabel G, Pereyra Milagros, Bcharah George, Farina Juan M, Ayoub Chadi, Sell-Dottin Kristen A, Arsanjani Reza
Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA.
Department of Cardiovascular Surgery, Mayo Clinic, Phoenix, AZ 85054, USA.
J Cardiovasc Dev Dis. 2024 Nov 30;11(12):384. doi: 10.3390/jcdd11120384.
Bioprosthetic aortic valve degeneration (BAVD) is a significant clinical concern following both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). The increasing use of bioprosthetic valves in aortic valve replacement in younger patients and the subsequent rise in cases of BAVD are acknowledged in this review which aims to provide a comprehensive overview of the incidence, diagnosis, predictors, and management of BAVD. Based on a thorough review of the existing literature, this article provides an updated overview of the biological mechanisms underlying valve degeneration, including calcification, structural deterioration, and inflammatory processes and addresses the various risk factors contributing to BAVD, such as patient demographics, comorbidities, and procedural variables. The difficulties in early detection and accurate diagnosis of BAVD are discussed with an emphasis on the need for improved imaging techniques. The incidence and progression of BAVD in patients undergoing TAVR versus SAVR are compared, providing insights into the differences and similarities between the two procedures and procedural impacts on valve longevity. The current strategies for managing BAVD, including re-intervention options of redo surgery and valve-in-valve TAVR, along with emerging treatments are discussed. The controversies in the existing literature are highlighted to offer directions for future investigations to enhance the understanding and management of BAVD.
生物人工主动脉瓣退变（BAVD）是经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）后一个重要的临床问题。本综述承认生物人工瓣膜在年轻患者主动脉瓣置换术中的使用增加以及随后BAVD病例的上升，旨在全面概述BAVD的发病率、诊断、预测因素和管理。基于对现有文献的全面回顾，本文提供了瓣膜退变潜在生物学机制的最新概述，包括钙化、结构恶化和炎症过程，并阐述了导致BAVD的各种风险因素，如患者人口统计学特征、合并症和手术变量。讨论了BAVD早期检测和准确诊断的困难，强调了改进成像技术的必要性。比较了接受TAVR与SAVR患者中BAVD的发病率和进展情况，深入了解两种手术之间的差异和相似之处以及手术对瓣膜寿命的影响。讨论了当前管理BAVD的策略，包括再次手术和瓣膜内瓣膜TAVR等再次干预选项以及新兴治疗方法。强调了现有文献中的争议，为未来研究提供方向，以加强对BAVD的理解和管理。
