Standardised Definitions of Structural Deterioration and Valve Failure in Assessing Long-Term Durability of Transcatheter and Surgical Aortic Bioprosthetic Valves: A Consensus Statement from The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

Despite continuing efforts during the last decades, there is no ‘ideal prosthetic valve substitute’. Every valve prosthesis invokes new pathophysiological processes, including the risks of thromboembolism, prosthetic endocarditis, and structural valve deterioration (SVD) or non-structural valve deterioration with consequent need for reintervention (Figure 1). Bioprostheses are now increasingly used in preference to mechanical valves in the aortic position but valve dysfunction may occur over time. The literature concerning surgical prostheses has taught us that bioprosthetic valve dysfunction is a complex phenomenon whose understanding requires more than the reporting of reintervention. Further research must encompass biological, pathological and haemodynamic mechanisms, use of contemporary non-invasive imaging, evaluation of the true incidence while avoiding methodological pitfalls, and identification of clinical, technical, and prosthesis-specific predictors.