Bioprosthesis (BP) structural deterioration after aortic valve replacement (AVR) is generally defined by re-operation for BP failure. This approach underestimates the incidence of structural valve deterioration. We intended to determine the incidence, predictors and impact of valve hemodynamic deterioration (VHD) assessed by echocardiography (TTE).

A total of 1387 patients (62.2% male; 70.5±7.8 years old) were retrospectively included. A baseline TTE was performed at a median time of 4.1 (1.3–6.5) months post-AVR. TTE follow-up was performed at least 2-years post-AVR in all patients, at least 5-years in 926 patients and at least 10-years in 385 patients. VHD was defined as: >10mmHg increase in mean gradient (MG) and/or worsening of regurgitation >1/3 grade from baseline to last TTE follow-up.

Overall, VHD was identified in 428 patients (30.9%). The VHD occurred within the first 5 years in 181 (42.3%) patients and after 5 years in 247(57.7%) patients. VHD was a predictor of death (HR: 2.18, 95% CI: 1.86 to 2.57, P<0.001). Diabetes (HR: 1.33, 95% CI: 1.06 to 1.66, P=0.01), post-surgery MG>15mmHg (HR: 1.30, 95% CI: 1.05 to 1.62, P=0.02), severe PPM (HR: 1.85, 95% CI: 1.12 to 2.87, P=0.02) and type of BP (P<0.001) were associated with VHD. Predictors of early VHD identified (within the first 5-years post-AVR) were: diabetes (P=0.01), active smoker status (P=0.01), renal insufficiency (P=0.01), post-surgery MG>15mmHg (P=0.04), post-surgery>mild transprosthetic regurgitation (P=0.04) and type of BP (P=0.003). Predictors of late VHD (i.e. after the 5 years) were: female sex (P=0.03), coumadin (P=0.007) and type of BP (P<0.001).

VHD as documented by TTE is frequent (30%) following AVR and associated with 2.2-fold increase in mortality. The main factors associated with VHD were female sex, diabetes, smoking, coumadin, presence of severe prosthesis-patient mismatch, high residual gradient, and/or regurgitation early after AVR.