Current definitions of hemodynamic structural valve deterioration after bioprosthetic aortic valve replacement lack consistency

JTCVS Open, vol. 19, pp. 68–90

Abstract

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.

Authors 9

1. Bart J.J. Velders corresponding Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

2. Michiel D. Vriesendorp Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

3. Federico M. Asch Aachen Department of Clinical Epidemiology

   Houston Methodist · Georgetown University · University Hospitals of Cleveland · Leiden University Medical Center · ProMedica Toledo Hospital · University Hospitals Cleveland Medical Center · Institut universitaire de cardiologie et de pneumologie de Québec · ProMedica · MedStar Health Research Institute · Case Western Reserve University

   Affiliation as printed

   Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada

   Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio

   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 Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

   Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio

4. Michael J. Reardon

   Houston Methodist · Georgetown University · MedStar Health Research Institute

   Affiliation as printed

   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

5. François Dagenais

   Georgetown University · Institut universitaire de cardiologie et de pneumologie de Québec · MedStar Health Research Institute

   Affiliation as printed

   Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada

   Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC

6. Michael G. Moront

   Georgetown University · ProMedica Toledo Hospital · ProMedica · MedStar Health Research Institute

   Affiliation as printed

   Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio

   Department of Cardiovascular Core Laboratories, MedStar Health Research Institute, and Georgetown University, Washington, DC

7. Joseph F. Sabik

   Georgetown University · University Hospitals of Cleveland · University Hospitals Cleveland Medical Center · MedStar Health Research Institute · Case Western Reserve University

   Affiliation as printed

   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

8. Rolf H. H. Groenwold Aachen Department of Clinical Epidemiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

9. Robert J.M. Klautz Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands