Increased utilization of bioprosthetic aortic valve technology:Trends, drivers, controversies and future directions

Steven S Qi, Rosemary F. Kelly, Richard Bianco, Frederick J. Schoen

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Bioprosthetic valves (BPV) implanted surgically or by transcatheter valve implantation (TAVI) comprise an overwhelming majority of substitute aortic valves implanted worldwide. Areas Covered: Prominent drivers of this trend are: 1) BPV patients have generally better outcomes than those with a mechanical valve, and remain largely free of anticoagulation and its consequences; 2) BPV durability has improved over the years; and 3) the expanding use of TAVI and valve-in-valve (VIV) procedures permitting interventional management of structural valve degeneration (SVD). Nevertheless, key controversies exist: 1) optimal anticoagulation regimens for surgical and TAVI BPVs; 2) the incidence, mechanisms and mitigation strategies for SVD; 3) the use of VIV for treatment of SVD, and 4) valve selection recommendations for difficult cohorts, (e.g. patients 50–70 years, patients <50, childbearing age women). This communication reviews trends in and drivers of BPV utilization, current controversies, and future directions affecting BPV use. Expert Opinion: Long-term data are needed in several areas related to aortic BPV use, including anticoagulation/antiplatelet therapy, especially following TAVI. TAVI and especially VIV durability and optimal use warrant will benefit greatly from long-term data. Certain populations may benefit from such high-quality data on multi-year outcomes, particularly younger patients.

Original languageEnglish (US)
Pages (from-to)537-546
Number of pages10
JournalExpert review of cardiovascular therapy
Volume19
Issue number6
DOIs
StatePublished - Jun 2 2021

Bibliographical note

Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.

Keywords

  • Anticoagulation
  • aortic valve
  • bioprosthetic valve
  • structural valve degeneration calcification
  • transcatheter valve implantation (TAVI)
  • valve thrombosis
  • valve-in-valve

PubMed: MeSH publication types

  • Journal Article
  • Review

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