Internal medicine

Pathology

Heart valve

Structural engineering

Engineering

Cardiology

Infiltration (HVAC)

Composite material

Materials science

Inflammation

Degeneration (medical)

Structural failure

Calcification

Medicine

Journal of the American Heart Association

Bioprosthetic heart valves (BHVs) largely circumvent the need for long-term anticoagulation compared with mechanical valves but are increasingly susceptible to deterioration and reduced durability with reoperation rates of ≈10% and 30% at 10 and 15 years, respectively. Structural valve degeneration is a common, unpreventable, and untreatable consequence of BHV implantation and is frequently characterized by leaflet calcification. However, 25% of BHV reoperations attributed to structural valve degeneration occur with minimal leaflet mineralization. This review discusses the noncalcific mechanisms of BHV structural valve degeneration, highlighting the putative roles and pathophysiological relationships between protein infiltration, glycation, oxidative and mechanical stress, and inflammation and the structural consequences for surgical and transcatheter BHVs.

Noncalcific Mechanisms of Bioprosthetic Structural Valve Degeneration