title: Incidence, risk factors, clinical impact, and management of bioprosthesis structural valve degeneration.
abstract: OBJECTIVE
  Structural valve deterioration is the major cause of bioprosthesis failure and is increasing over time. We present an overview of incidence, mechanisms, predictors, clinical impact, and management of bioprosthetic valve structural degeneration.
  
  
  RESULTS
  Early degeneration caused by calcification and destruction of connective tissue of the prosthesis is controlled by multiple mechanisms, from mechanical stress to infiltration of lipids and inflammatory cells, and activation of the immune system. Despite major improvements in valve design and surgical procedures, the pathology is still the main limiting factor to the long-term durability. Appropriate selection of the model and size of bioprosthesis as well as proper medical management and follow-up after valve replacement are essential for optimal prevention, detection, and management of structural valve deterioration. Currently, redo open-heart surgery is the most frequently used approach to treat structural valve deterioration. The transcatheter valve-in-valve procedure, however, is a valuable alternative to surgery for high-risk patients.
  
  
  CONCLUSIONS
  Structural valve deterioration is responsible for significant morbidity and mortality after valve replacement. This multifactorial pathology is the main cause of valve re-intervention during follow-up. Although redo surgery is still the most frequently used intervention to treat valve structural failure, the transcatheter valve-in-valve procedure is rapidly expanding.
authors.affiliation: Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec City, Quebec, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Côté
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Clavel
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis; D019544:Equipment Failure Analysis; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome