Standardized Definitions for Bioprosthetic Valve Dysfunction Following Aortic or Mitral Valve Replacement: JACC State-of-the-Art Review

Philippe Pibarot, Howard C Herrmann, Changfu Wu, Rebecca T Hahn, Catherine M Otto, Amr E Abbas, John Chambers, Marc R Dweck, Jonathon A Leipsic, Matheus Simonato, Toby Rogers, Janarthanan Sathananthan, Mayra Guerrero, Julien Ternacle, Harindra C Wijeysundera, Lars Sondergaard, Marco Barbanti, Erwan Salaun, Philippe Généreux, Tsuyoshi KanekoUri Landes, David A Wood, G Michael Deeb, Stephanie L Sellers, John Lewis, Mahesh Madhavan, Linda Gillam, Michael Reardon, Sabine Bleiziffer, Patrick T O'Gara, Josep Rodés-Cabau, Paul A Grayburn, Patrizio Lancellotti, Vinod H Thourani, Jeroen J Bax, Michael J Mack, Martin B Leon, Heart Valve Collaboratory


Bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF) may be caused by structural or nonstructural valve dysfunction. Both surgical and transcatheter bioprosthetic valves have limited durability because of structural valve deterioration. The main objective of this summary of experts participating in a virtual workshop was to propose standardized definitions for nonstructural and structural BVD and BVF following aortic or mitral biological valve replacement with the goal of facilitating research reporting and implementation of these terms in clinical practice. Definitions of structural BVF, based on valve reintervention or death, underestimate the true incidence of BVF. However, definitions solely based on the presence of high transprosthetic gradient at a given echocardiogram during follow-up overestimate the incidence of structural BVD and BVF. Definitions of aortic or mitral structural BVD must therefore include the confirmation by imaging of permanent structural changes to the leaflets alongside evidence of deterioration in valve hemodynamic function at echocardiography follow-up.

Original languageEnglish
JournalJournal of the American College of Cardiology
Issue number5
Pages (from-to)545-561
Number of pages17
Publication statusPublished - 2 Aug 2022


  • Aortic Valve/diagnostic imaging
  • Aortic Valve Stenosis/surgery
  • Bioprosthesis/adverse effects
  • Heart Valve Diseases/surgery
  • Heart Valve Prosthesis/adverse effects
  • Humans
  • Mitral Valve/diagnostic imaging
  • Prosthesis Design
  • Prosthesis Failure
  • Transcatheter Aortic Valve Replacement/methods
  • Treatment Outcome


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