P1808 The impact of valve type in morbimortality of patients with infectious endocarditis

Abstract Introduction Infectious endocarditis (IE) represents one of the main causes of morbimortality in patients (pts) with valvular heart disease. Prosthetic valves infection is usually associated with worse outcomes. Aim To compare the clinical features and adverse outcomes of patients with native vs prosthetic valve IE. Methods We analysed a population with suspected/confirmed IE, according to Duke criteria, in the last 12 years (2006-2017). The clinical and imaging data were collected as well as complication rates and mortality data. Results 174 pts, 75% males with mean age of 61 ± 16 years. Native valve EI occurred in 74,1%. of pts. 25,3% had heart failure (HF), 16,1% chronic kidney disease(7,1% on haemodialysis), 12,8% HIV infection, 9,3% active neoplasm and 7,1% were on immunosuppression. 16 pts with native valve disease had previous valvular disease: 1 congenital valve disease, 2 with rheumatic heart disease, 3 with previous IE and 10 with degenerative disease. At admission: 73,1% had fever, 53,2% murmur and 47,9% anemia. The majority (78,4%) had single valve IE and 15,8% had double valve involvement. Aortic valve (AoV) was affected in 54% of the cases and mitral valve involvement was seen in 43,7%. 13,3% had right valve disease. S. Aureus was the most frequent microrganism. Echocardiographic findings: 87,7% had vegetation, 21,2% valve destruction , 5,6% valve obstruction, 14,3% abscess, 3,7% valve aneurysm, 5,6% pseudoaneurysm and 5,6% fistula. Regurgitation was observed in 62,1%. The intrahospitalar mortality was 29,9%. Comparing both groups, pts with prosthetic IE had more previous history of HF (40,5% vs 20,5% p = 0,009) and diabetes (31,7% vs 15,3% p = 0,020). No differences were found in what concerns microrganisms involved. Echocardiographically, pts with prosthetic valve had predominantly AoV involvement (81,1% vs 45,5% p < 0,001), less vegetation (75% vs 91,8% p = 0,01) and less regurgitation (45% vs 67,8% p = 0,01). They had more local complications (61% vs 27,7% p> 0,001) like valve obstruction (12,5% vs 3,3% p = 0,043), abscess (32,5% vs 8,3% p> 0,001) or pseudoaneurysm (17,5% vs 1,7% p= 0,001). In what concerns morbidity burden, developed more HF during hospitalization (56,1% vs 37,7% p= 0,037) as well as more isquemic and haemorragic stroke(85,7% vs 42,3%. P = 0,004 and 28,6% vs 2,4% p = 0,012, respectively). However there were no differences regarding the development of septic shock (p = 0,542) or overall embolization (p = 0,732). At last, no differences were found in intrahospitalar(IH) mortality (p = 0,085), relapse (p = 0,573) or overall survival between both groups (log rank: 1,5, p = 0,217). Conclusion Pts with prosthetic valve IE usually have worse outcomes. However,for this population,we conclude that besides having more HF and stroke, there were no differences in what concerns septic shock or overall embolization, as well as IH mortality and survival between both groups.

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Clinical outcomes of Japanese atrial fibrillation patients with combined valvular heart disease: the Fushimi AF Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0528 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Doi ◽

K Ishigami ◽

Y Aono ◽

S Ikeda ◽

Y Hamatani ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Incidence Rate ◽

Clinical Outcomes ◽

Valvular Heart Disease ◽

Cardiac Death ◽

Clinical Characteristics ◽

Valve Disease ◽

The Impact

Abstract Background We previously reported that valvular heart disease (VHD) was not at the significant risk of stroke/systemic embolism (SE), but was associated with an increased risk of hospitalization for heart failure (HF) in Japanese atrial fibrillation patients. However, the impact of combined VHD on clinical outcomes has been little known. Purpose The aim of this study is to investigate the prevalence of combined VHD and its clinical characteristics and impact on outcomes such as stroke/SE, all-cause death, cardiac death and hospitalization for HF. Method The Fushimi AF Registry is a community-based prospective survey of AF patients in one of the wards of our city which is a typical urban district of Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. In the entire cohort, echocardiography data were available for 3,574 patients. 68 AF patients with prosthetic heart valves were excluded and we compared clinical characteristics and outcomes between 488 single VHD (103 Aortic valve disease (AVD), 315 mitral valve disease (MVD), 70 tricuspid valve disease (TVD)) and 158 combined VHD (46 AVD and MVD, 11 AVD and TVD, 66 MVD and TVD, 35 AVD and MVD and TVD). Result Compared with single VHD, patients with combined VHD were older (combined vs. single VHD: 78.5 vs. 76.0 years, respectively; p<0.01), more likely to have persistent/permanent type AF (73.4% vs. 63.9%, p=0.02) and prescription of warfarin (63.1% vs. 53.8%, p=0.04). Combined VHD was less likely to have diabetes mellitus (13.9% vs. 23.6%, p=0.01) and dyslipidemia (26.6% vs. 40.4%, p<0.01). Sex, body weight, hypertension, pre-existing HF were comparable between the two groups. During the median follow-up of 1,474 days, the incidence rate of stroke/SE was not significantly different between the two groups (1.58 vs. 1.89 per 100 person-years, respectively, log rank p=0.10). The incidence rate of all-cause death (7.35 vs. 5.33, p=0.65), cardiac death (1.20 vs. 0.99, p=0.91) and hospitalization for HF (5.55 vs. 4.43, p=0.53) were also not significantly different. We previously reported AVD had significant impacts on cardiac adverse outcomes in AF patients, and we further analyzed event rates between combined VHD including AVD (AVD and MVD/TVD) and without AVD (MVD and TVD). Combined VHD with AVD group had higher incidence rate of all-cause death (10.7 vs. 5.79, p=0.03) than that without AVD group. However, the incidence rate of stroke/SE (1.98 vs. 1.56, p=0.59), cardiac death (0.98 vs. 1.14, p=0.68), hospitalization for HF (8.03 vs. 5.38, p=0.17) were not significantly different between the two groups. Conclusion As compared with single VHD, the risk of stroke/SE, all-cause death, cardiac death and hospitalization for HF in combined VHD was not significantly different. Among patients with combined VHD, those having AVD had higher incidence rate of all-cause death than those without AVD. Figure 1 Funding Acknowledgement Type of funding source: None

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P2744Age distribution of valvular heart disease in China: from a national multicenter prospective cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.1061 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

B Zhang ◽

H T Zhang ◽

H Y Xu ◽

Y J Wu

Keyword(s):

Logistic Regression ◽

Cohort Study ◽

Heart Disease ◽

Mitral Valve ◽

Valvular Heart Disease ◽

Mitral Valve Disease ◽

Multimodality Imaging ◽

Valve Disease ◽

Multivariate Logistic Regression ◽

The Impact

Abstract Background Valvular heart disease (VHD) has been caught in two important cross-currents in recent decades: aging demography and the rise of multimodality imaging and transcatheter valve therapy. In this setting, we aim to identify the distribution, characteristics, and management of Chinese VHD patients according to age. Methods China Valvular Heart Disease Cohort Study (China-VHD) was conducted from March to September 2019 in 46 centers over China. It included prospectively 12331 adults with native moderate or severe VHD, of which we described the distribution, management, and in-hospital events according to age (18–44, 45–54, 55–64, 65–74, ≥75). Multivariate Logistic regression was employed to investigate the impact of age on in-hospital events composed of in-hospital mortality, acute heart failure, and stoke. Results In Chinese VHD population, overall percentage peaked in 55–64 year olds. The frequency of multivalvular heart disease (MVHD) saw an increasing trend with age (p for trend <0.001). Of single valvular heart disease, mitral regurgitation (MR) was the most frequent left-sided VHD followed by aortic regurgitation (AR), aortic stenosis (AS), and mitral stenosis (MS). AS frequency significantly grew with age (p for trend = 0.02) while AR peaked in 18–44 year olds and fluctuated at a lower level in the older population. In contrast, mitral valve disease (MS, MR, and mixed mitral valve disease) was most frequent in 45–54 year olds and dropped with age (p for trend all <0.001). Noteworthily, all aortic valve disease was notably frequent in men whereas mitral valve disease and MVHD more common in women. Similar to developed countries, degenerative etiology rose steeply while rheumatic and congenital origin fell with age. Regarding management, surgical valve replacement rate was similar in age groups lower than 75 years old with increasing frequency of concomitant CABG. No matter aortic or mitral, the percentage of bio-prosthesis rocketed after 65 years (aortic: 74.7%, mitral: 70.6%). In multivariate logistic regression, covariables included age, sex, BMI, hypertension, diabetes, coronary heart disease, aortic disease, cardiomyopathy, COPD, NYHA class and valvular intervention. Compared to patients younger than 45, in-hospital events significantly higher in patients over 75 only (OR: 1.69 [95% CI: 1.07–2.66], p<0.02). Moreover, women showed a lower risk of in-hospital events (OR: 0.78 [95% CI: 0.63–0.96], p<0.01). Age distribution of VHD Conclusion Age plays a crucial role in valvular heart disease, best illustrated in AS. Unlike the western world, AR and MR are more frequent than AS but show a slightly decreasing trend with age. As expected, degenerative etiology is becoming more prevalent whereas rheumatism decreases. Age over 75 and male are associated with growing in-hospital events. Degenerative VHD thus present an important public-health burden. Acknowledgement/Funding Innovation project of Chinese academy of medical science

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P2746Survival of people with valvular heart disease in the community (OxValve-Survive)

European Heart Journal ◽

10.1093/eurheartj/ehz748.1063 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Taylor ◽

J M Ordonez-Mena ◽

A K Roalfe ◽

J Wilson ◽

S Myerson ◽

...

Keyword(s):

Heart Disease ◽

Cause Of Death ◽

Valvular Heart Disease ◽

Cox Regression ◽

Severe Disease ◽

Research Centre ◽

Mortality Data ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Abstract Background Valvular heart disease (VHD) occurs commonly in older patients (>65 years) but the majority is mild disease, which is of uncertain importance. Understanding the impact of VHD on mortality in this older group of patients would help determine its relevance and aid the appropriate use of healthcare resources. OxValve is a cohort study in Oxfordshire screening people aged 65 and over for VHD. Over 4,009 participants were recruited between August 2009 and May 2016 and screened using echocardiography to establish the presence and severity of VHD. AIMS To report survival in the OxValve cohort, and to investigate whether people with VHD are at increased risk of death. Methods The OxValve cohort was linked to Office for National Statistics mortality data to obtain date and cause of death. Cox regression was used to investigate the association of any VHD, VHD of significant severity, and VHD subtypes with all-cause and cause-specific mortality, adjusting for potential confounders including age, sex, socioeconomic status, smoking, and comorbidities. Results Linked mortality data was available for 3,511 OxValve participants up to September 2018 (median 5.85 years follow-up). VHD was present in 2,645 (75.3%) participants and of these 288 (8.2%) had significant VHD. In total, 311 (8.9%) participants had died. Cancer was the commonest cause of death (n=135), followed by cardiovascular disease (n=75) and respiratory disease (n=35). After adjustment for age and other covariates, mild to moderate VHD was not associated with increased all-cause mortality (HR 1.16, 95% CI: 0.89 to 1.50). However, VHD of significant severity (moderate or severe disease) was associated with a nearly two-fold higher risk of death overall (HR 1.92, 95% CI: 1:38 to 2.67) including increased CVD mortality (HR 2.25, 95% CI: 1.21 to 4.18). DISCUSSION Mild to moderate VHD was very common, but was not associated with increased mortality. Significant VHD was however associated with a two-fold reduction in survival. Further research is required to understand the natural history of VHD, how to identify those with progressive disease and when to intervene. Acknowledgement/Funding NIHR Biomedical Research Centre, Oxford

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Abstract TP127: Periprocedual Risk of Treatment for Carotid Stenosis Complicated With Cardiac Disease - J-ASPECT Study

Stroke ◽

10.1161/str.51.suppl_1.tp127 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ataru Nishimura ◽

Kunihiro Nishimura ◽

Daisuke Onozuka ◽

Akiko Kada ◽

Ai Kurogi ◽

...

Keyword(s):

Heart Disease ◽

Aortic Valve ◽

Carotid Artery ◽

Aortic Valve Disease ◽

Patient Characteristics ◽

Valvular Disease ◽

Valve Disease ◽

Comorbid Condition ◽

Risk Of Death ◽

The Impact

Background and Purpose: Heart disease is a common comorbid condition among patients undergoing carotid endarterectomy (CEA) and carotid artery stent placement (CAS). However, the outcomes of patients with heart disease who were treated with CEA/CAS have not been fully examined. We investigated the impact of heart disease on outcomes of CEA and CAS in general practice using the Japanese nationwide data from J-ASPECT study. Methods: We analyzed data from 23,366 patients of CEA or CAS (CEA 8,514, CAS 14,809) who had been hospitalized in the period from April 2012 to March 2017. We extracted data from the Japanese nationwide DPC database for patients who underwent CEA or CAS which were identified from procedural coding with Japanese original K-codes (CEA: K6092, CAS: K609-2). For further categorization of carotid artery stenosis patients with or without heart disease, we used the ICD-10 code (ischemic heart disease, valvular disease cardiomyopathy, conduction disturbance, cardiac arrhythmia, atrial fibrillation/atrial flutter and heart failure) to identify the presence of heart disease. Outcome (death within 30days) was compared between the patient who underwent CEA or CAS and patient with or without heart disease after adjustment for patient characteristics by using the logistic regression analysis. Results: Of the patients who underwent CAS or CEA, 2495 (29.3%) in CEA and 3930 (26.5%) in CAS were complicated with heart disease. Heart disease was not associated with the risk of death within 30days in both patients undergoing CEA (OR, 1.38; 95% CI, 0.54-3.55, p=0.5) or CAS (OR, 1.42; 95% CI, 0.93-2.16, p=0.099). Among heart disease, valvular disease was associated with increased the risk of death within 30days in patients undergoing CEA (OR, 6.71; 95% CI, 1.89-23.77, p=0.0032) and CAS (OR, 2.94; 95% CI, 1.05-8.20, p=0.004) after adjustment for potential confounders. Especially of the patients with valvular disease, aortic valve disease was significantly increased the risk of death within 30days (CEA: OR, 11.2; 95% CI, 3.13-39.8, p=0.0002, CAS: OR, 3.53; 95% CI, 1.07-11.6, p=0.038). Conclusion: Patients who were complicated with valvular disease, especially aortic valve disease had a high risk of death within 30 days after CEA or CAS.

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Combined and multiple valve diseases

ESC CardioMed ◽

10.1093/med/9780198784906.003.0771 ◽

2018 ◽

pp. 1688-1688

Author(s):

Michele De Bonis ◽

Patrizio Lancellotti

Keyword(s):

Heart Disease ◽

Natural History ◽

Valvular Heart Disease ◽

General Rule ◽

Valve Disease ◽

Pressure Gradients ◽

Moderate Severity ◽

Combined Lesions ◽

Valve Diseases ◽

The Impact

Management of multiple valve disease is dictated by the pathology of the valve which is predominantly involved. As a general rule, in combined lesions, valvular heart disease is considered severe even if both stenosis and regurgitation are only of moderate severity, and pressure gradients become of major importance for assessment. However more data on the natural history and the impact of intervention on outcome are required to better define the indications for intervention.

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Health and productivity burden of coronary heart disease in the working Indonesian population using life-table modelling

BMJ Open ◽

10.1136/bmjopen-2020-039221 ◽

2020 ◽

Vol 10 (9) ◽

pp. e039221 ◽

Cited By ~ 1

Author(s):

Regina E Uli ◽

Regina P U Satyana ◽

Ella Zomer ◽

Dianna Magliano ◽

Danny Liew ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Life Table ◽

Secondary Outcome ◽

Mortality Data ◽

Retirement Age ◽

Years Of Life Lost ◽

Life Years ◽

Working Age ◽

The Impact

ObjectivesThe impact of coronary heart disease (CHD) and its effect on work productivity at a population level remains unknown in Indonesia. This study estimates the health and productivity lost to CHD in terms of years of life, quality-adjusted life years (QALYs) and productivity-adjusted life years (PALYs).Setting and participantsA life-table model was constructed to simulate the experiences of Indonesians currently aged 15–54 years (working age) with CHD, followed-up to 55 years (retirement age). The life-table analysis was then repeated assuming that the cohort did not have CHD. Differences in the results reflected the impact of CHD. Demographical, prevalence and mortality data were based on the 2017 Global Burden of Disease study and 2018 Indonesian National Health Survey. Costs, productivity indices and utilities were derived from published sources. The cost of each PALY was assumed to be equivalent to gross domestic product per equivalent full-time worker (US$11 765). Future costs and outcomes were discounted by 3% annually.Primary and secondary outcome measuresDifferences in total deaths, years of life and PALYs represented the impact of CHD.ResultsAt present, 1 954 543 (1.45%) Indonesians of working-age have CHD. By retirement age, it was estimated that CHD resulted in 32 492 (36.6%) excess deaths, 128 132 (0.5%) years of life lost, 2 331 495 (10.5%) QALYs lost and 1 589 490 (6.9%) PALYs lost. The economic impact of lost productivity amounted to US$33.3 billion, and healthcare costs to US$139 billion.ConclusionThe health and economic burden of CHD in Indonesia looms large. This highlights the importance of its prevention and control, strategies for which, if effective, will deliver financial return.

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Reliability and construct validity of the Instrument to Measure the Impact of Valve Heart Disease on the Patient's Daily Life

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.0624.2730 ◽

2016 ◽

Vol 24 (0) ◽

Author(s):

Daniela Brianne Martins dos Anjos ◽

Roberta Cunha Matheus Rodrigues ◽

Kátia Melissa Padilha ◽

Rafaela Batista dos Santos Pedrosa ◽

Maria Cecília Bueno Jayme Gallani

Keyword(s):

Heart Disease ◽

Heart Valve ◽

Daily Life ◽

Temporal Stability ◽

Valve Disease ◽

Heart Valve Disease ◽

Floor Effect ◽

Phone Calls ◽

The Impact ◽

Valve Heart Disease

ABSTRACT Objective: evaluate the practicality, acceptability and the floor and ceiling effects, estimate the reliability and verify the convergent construct's validity with the instrument called the Heart Valve Disease Impact on daily life (IDCV) of the valve disease in patients with mitral and or aortic heart valve disease. Method: data was obtained from 86 heart valve disease patients through 3 phases: a face to face interview for a socio-demographic and clinic characterization and then other two done through phone calls of the interviewed patients for application of the instrument (test and repeat test). Results: as for the practicality and acceptability, the instrument was applied with an average time of 9,9 minutes and with 110% of responses, respectively. Ceiling and floor effects observed for all domains, especially floor effect. Reliability was tested using the test - repeating pattern to give evidence of temporal stability of the measurement. Significant negative correlations with moderate to strong magnitude were found between the score of the generic question about the impact of the disease and the scores of IDCV, which points to the validity of the instrument convergent construct. Conclusion: the instrument to measure the impact of valve heart disease on the patient's daily life showed evidence of reliability and validity when applied to patients with heart valve disease.

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The impact of pneumococcal vaccination on pneumonia mortality among the elderly in Japan: a difference-in-difference study

PeerJ ◽

10.7717/peerj.6085 ◽

2018 ◽

Vol 6 ◽

pp. e6085 ◽

Cited By ~ 4

Author(s):

Sung-mok Jung ◽

Hyojung Lee ◽

Hiroshi Nishiura

Keyword(s):

Heart Disease ◽

Causal Effect ◽

Pneumococcal Vaccination ◽

Malignant Neoplasm ◽

Population Level ◽

The Elderly ◽

Mortality Data ◽

Control Group ◽

Difference In Difference ◽

The Impact

Background It is plausible that the routine immunization among infants using pneumococcal conjugate vaccine 13 (PCV13) from 2013 and among the elderly using pneumococcal polysaccharide vaccine 23 (PPV23) from 2014 contributed to reducing the pneumonia mortality among the elderly in Japan. The present study aimed to estimate the causal effect of this vaccination on pneumonia mortality, using the available cause-of-death data and employing a difference-in-difference (DID) design. Methods Two types of mortality data, that is, prefecture-dependent and age- and gender-specific mortality data, from 2003 to 2017 were retrieved. We used mortality due to malignant neoplasm and heart disease as control groups and employed a DID design with an assumed parallel mortality trend between pneumonia and control group mortality since 2013 to estimate the causal effect of pneumococcal vaccination from 2014. Results Our estimation based on malignant neoplasm and heart disease as controls indicated that the reduced pneumonia mortality in 2017 owing to pneumococcal vaccination was as large as 41.9 (33.2, 50.6) and 31.2 (23.8, 38.6) per 100,000 individuals, respectively. The largest mortality reduction was observed for the oldest group (aged ≥90 years), especially among men. Discussion The pneumococcal vaccination program, perhaps mainly represented by high vaccination coverage of PCV13 among children and partly by PPV23 administration with low coverage among the elderly in Japan, was shown to have reduced the pneumonia mortality in the elderly at the population level.

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The Impact of Maternal Congenital Heart Disease on Pregnancy Outcomes in Malta – a Retrospective Study

International Cardiovascular Forum Journal ◽

10.17987/icfj.v11i0.416 ◽

2017 ◽

Vol 11 ◽

Author(s):

Maryanne Caruana ◽

Miriam Gatt ◽

Oscar Aquilina ◽

Charles Savona Ventura ◽

Victor Grech ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pregnancy Outcomes ◽

Congenital Heart ◽

Negative Impact ◽

Clinical Status ◽

Cardiovascular Complications ◽

Complication Rates ◽

Vaginal Deliveries ◽

The Impact

Background: Most female patients with congenital heart disease (CHD) are becoming pregnant. Maternal CHD can have a negative impact on mother and foetus. This is the first study investigating pregnancy outcomes in Maltese grown-up congenital heart disease (GUCH) patients and one of few to compare these with outcomes in women without heart disease.Methods: Known GUCH pregnancies for the period of 2007-2014 were extracted from our database (GUCH cohort) and cardiovascular outcomes retrieved from hospital notes. A control cohort of 540 pregnancies in women without cardiovascular disease was generated through twenty-fold random matching based on subject age from among all pregnancies in Maltese nationals for the same 8-year period. Obstetric and offspring outcomes were compared between the two cohorts.Results: The GUCH cohort consisted of 27 pregnancies in 24 women. Only 1/27 patients (3.7%) had cardiovascular complications. Elective Caesarean sections were commoner (29.6% vs. 15.4%) and unassisted vaginal deliveries less frequent (51.9% vs. 64.6%) in the GUCH cohort (p=0.02). Obstetric complication rates were similar. GUCH women had smaller babies (median 3030g vs. 3230g; p=0.045) and showed a trend towards more small-for-gestational age babies (18.5% vs. 8.4%; p=0.08) and congenital malformations (7.4% vs. 2.4%; p=0.06).Conclusions: Despite the potential adverse effects of maternal CHD on mother and foetus, most pregnancies are uncomplicated and outcomes comparable to those in women without heart disease, particularly if baseline clinical status is good. Based on our findings, it is being proposed that prospective mothers be counselled about the possibility of having smaller infants.

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Modern understanding of mechanisms of bioprosthetic valve structural degeneration: a literature review

Russian Journal of Cardiology ◽

10.15829/1560-4071-2018-11-145-152 ◽

2018 ◽

pp. 145-152

Author(s):

A. E. Kostyunin ◽

E. A. Ovcharenko ◽

K. Yu. Klyshnikov

Keyword(s):

Literature Review ◽

Prosthetic Valve ◽

Heart Valves ◽

Current Data ◽

Bioprosthetic Valve ◽

Valve Disease ◽

Hemodynamic Parameters ◽

Native Valve ◽

Mechanical Valves ◽

Bioprosthetic Valves

Bioprosthetic valves are often used to replace diseased heart valves. They differ from mechanical valves by optimal hemodynamic parameters and low thrombogenicity. However, although the durability of modern bioprosthetic valves, their design, and implantation procedures are being improved, the replacement of the native valve does not necessarily lead to favorable outcome, because valvular defect is often replaced by “prosthetic valve disease”. Structural valve degeneration is one of the main causes of bioprosthetic valve failure, but its mechanisms have not been studied in detail. This review summarizes and analyzes current data on mechanisms responsible for bioprosthetic valve structural degeneration. These mechanisms include passive degeneration, inflammation, fibrosis and osteogenesis.

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