Current Definitions of Hemodynamic Structural Valve Deterioration After Bioprosthetic Aortic Valve Replacement Lack Consistency

Objective Recently, new echocardiographic definitions have been proposed for hemodynamic structural valve deterioration (SVD). We aimed to study their consistency in classifying SVD after surgical aortic valve replacement (SAVR). Methods Data were used of SAVR patients implanted in a multicenter, prospective cohort study with 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 SVD was defined according to Capodanno et al., Dvir et al., and the Valve Academic Research Consortium (VARC) 3; regurgitation data was not considered in this analysis. Consistency was quantified based on SVD classification at subsequent timepoints. Results A total of 1118 patients were implanted. The mean age was 70 years and 75% were male. Hemodynamic SVD at any visit was present in 51 (4.6%), 32 (2.9%), and 34 (3.0%) patients according to Capodanno, Dvir, and VARC-3. 1064 (95%) patients were never labeled with SVD by any definition. After the first classification with SVD, 59%, 59%, and 65% had no subsequent SVD classification according to Capodanno, Dvir, and VARC-3, respectively. Conclusions The current definitions of hemodynamic SVD are strong negative predictors but inconsistent positive discriminators for the detection of stenotic hemodynamic SVD. While the diagnosis of SVD may be categorical, echocardiographic indices lack this degree of precision in the first 5-years after SAVR. The inconsistency of current SVD definitions impedes the detection of true valve degeneration, which challenges the clinical usefulness of these definitions.