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Structural Valve Degeneration — EECC MCQ

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EasyValvular Heart DiseaseStructural Valve DegenerationEECC

A 72-year-old woman with a bioprosthetic aortic valve has routine echocardiography showing mean gradient of 18 mmHg (previously 12 mmHg) and peak velocity of 3.0 m/s. She is asymptomatic. What is the likely cause of the gradual gradient increase?

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Correct answer: B — Structural valve degeneration (SVD) — the gradual increase in transprosthetic gradients over time reflects progressive leaflet calcification, fibrosis, and stiffening of the bioprosthesis; SVD typically becomes clinically relevant after 10-15 years for surgical bioprostheses and possibly earlier for TAVI valves

Structural valve degeneration (SVD) is the inevitable long-term limitation of all bioprosthetic valves — biological leaflets undergo progressive calcification, collagen degradation, and fibrosis over time. This manifests as gradually rising transprosthetic gradients and/or progressive regurgitation. Timelines: (1) surgical bioprosthetic AVR: freedom from SVD ~90% at 10 years, ~50-70% at 15 years, <40% at 20 years (varies by patient age — slower in elderly); (2) TAVI: limited long-term data; 5-year data show comparable durability to surgical bioprostheses, but 10-15 year data are awaited. The 2025 ESC VHD Guidelines recommend annual echocardiographic surveillance for bioprosthetic valves starting at 5 years post-implant (earlier if clinical concern). When SVD causes moderate-severe dysfunction with symptoms, reintervention (redo surgery or valve-in-valve TAVI) is indicated.

Reference: ESC/EACTS (2025): VHD Guidelines