Author + information
- Received July 26, 2019
- Revision received September 25, 2019
- Accepted October 1, 2019
- Published online January 20, 2020.
- Eric G. Butchart, MBBS,
- John Chambers, MD∗ (, )
- Jeffrey S. Borer, MD,
- Gary Grunkemeier, PhD and
- Ajit Yoganathan, PhD
- Members of the International Standards Organization (ISO) Cardiac Valves Standards (ISO 5840) Working Group
- ↵∗Address for correspondence:
Prof. John Chambers, Cardiothoracic Centre, Guy’s and St Thomas’ Hospitals, London SE1 7EH, United Kingdom.
• Echocardiographic definitions of structural valve deterioration must include a change in leaflet morphology accompanied by a deterioration in hemodynamic function.
• An absolute mean gradient equal or >20 mm Hg can occur as a result of patient-prosthesis mismatch and cannot, alone, be used to define structural valve deterioration.
• Studies of replacement valve durability should use core laboratories and report the percentage of patients having serial echocardiography.
As transcatheter valves are offered to progressively lower-risk patients, it is increasingly important to have accurate data about durability. Structural valve deterioration (SVD) implies an adverse change in the morphology of the leaflets and function of the valve compared with the state at implantation. However, a recent European statement allows SVD to be defined solely by a threshold mean gradient ≥20 mm Hg. Absolute mean gradients above this threshold may be observed immediately after implantation and represent patient–prosthesis mismatch and not SVD. This paper describes a definition of SVD more in keeping with routine clinical practice, incorporating a change in leaflet morphology and an increase in the grade of transvalvar regurgitation or an increase in gradient from the post-implantation study.
- structural valve deterioration
- surgical valve replacement
- transcatheter valve replacement
Prof. Chambers has been a consultant for Cryolife and Medtronic. Dr. Borer has been a consultant for Boehringer Ingelheim and Servier; and has served on Data Safety Monitoring Boards for GlaxoSmithKline, Alnylam, Novartis, Pfizer, and General Electric. Dr. Yoganathan has received research funding from Boston Scientific, Abbott, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 26, 2019.
- Revision received September 25, 2019.
- Accepted October 1, 2019.
- 2020 American College of Cardiology Foundation
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