Bioprosthetic Aortic Valve Hemodynamics: Definitions, Outcomes, and Evidence Gaps: JACC State-of-the-Art Review.

A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is complicated by the lack of standardization for labelling, definitions, and measurement techniques, both after surgical and transcatheter valve replacement. Echocardiography remains the standard assessment methodology because of its ease of performance, widespread availability, ability to do serial measurements over time, and correlation with outcomes. Management of a high gradient after replacement requires integration of the patient's clinical status, physical examination, and multimodality imaging in addition to shared patient decisions regarding treatment options. Future priorities that are underway include efforts to standardize prosthesis sizing and labelling for both surgical and transcatheter valves as well as trials to characterize the consequences of adverse hemodynamics.

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Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Herrmann has received institutional research funding from Abbott, Boston Scientific, Edwards Lifesciences, Highlife, Medtronic, and WL Gore; has received consulting fees from Edwards Lifesciences, Medtronic, Wells Fargo, and WL Gore; and has equity in Holistick Medical and Microinterventional Devices. Dr Pibarot has received funding from Edwards Lifesciences, Medtronic, Pi-Cardia, and Cardiac Phoenix for echocardiography core laboratory analyses and research studies in the field of transcatheter valve therapies, for which he received no personal compensation. Dr Hahn has received speaker fees from Abbott Structural and Edwards Lifesciences; has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Boston Scientific, Edwards Lifesciences, Medtronic, and Novartis; has served on the Scientific Advisory Board for Novartis; and has equity in Navigate. Dr Tang is a physician proctor and consultant for Medtronic; has served as a consultant and physician advisory board member for Abbott Structural Heart; has served as a consultant for NeoChord; and has served as a physician advisory board member for JenaValve. Dr Abbas has received research grants and consulting fees from Edwards Lifesciences. Dr Playford has received investigator-initiated research funding from Edwards Lifesciences, Pfizer, Novartis, Actelion, Bayer, and GlaxoSmithKline; is Chief Medical Advisor for Echo IQ; and has been a physician advisory board member for Edwards Lifesciences and AstraZeneca. Dr Ruel is a physician proctor for Medtronic (MICS CABG) and for Edwards Lifesciences (MICS AVR); has served as a steering committee member for Cryolife (PROACT Xa trial); and is a recipient of research funds from Medtronic (MIST trial). Dr Jilaihawi is a consultant to Boston Scientific, Edwards Lifesciences, and Medtronic; and has received grant/research support from Abbott Vascular, Edwards Lifesciences, and Medtronic. Dr Sathananthan is a consultant for and has received institutional research funding from Edwards Lifesciences and Medtronic; and has received speaker fees from NVT. Dr Wood is a consultant for and his institution (CCI-CIC) receives grant support from Edwards Lifesciences, Abbott Vascular, and Medtronic. Dr Bax’s institution (Department of Cardiology, LUMC, the Netherlands) has received research grants from Medtronic, Biotronik, Edwards Lifesciences, and Boston Scientific. Dr Rodes-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Del Nido is cofounder of Autus Valve Technologies, Inc. Dr Dweck is a consultant to Edwards Lifesciences and Medtronic; has received research funding from Edwards Lifesciences and Medtronic; and has received speaker fees from NVT. Dr Kaneko is a consultant for Edwards, Medtronic, Abbott, and 4C Medical. Dr Latib is a consultant for Medtronic, Edwards Lifesciences, Boston Scientific, and Abbott. Dr Moat is a full-time employee of Abbott Structural Heart, Inc. Dr Modine has received research grants from Edwards Lifesciences and Medtronic; and is a consultant for Abbott, Edwards Lifesciences, Medtronic, and Microport. Dr Popma is a full-time employee of Medtronic, Inc. Dr Smith has received institutional grants from Edwards Lifesciences, Medtronic, Abbott, and Cryolife; has received advisory board fees from Edwards Lifesciences; and has received speaking honoraria from Medtronic, Cryolife, Abbott, and Edwards Lifesciences. Dr Thomas is a full-time employee of Edwards Lifesciences. Dr Yoganathan is a Principal Consultant to CardioMed Device Consultants LLC in the Structural Heart Valve area; is on the Scientific Advisory Board of Foldax Inc; and has served as Educational Consultant to Boston Scientific, Edwards Lifesciences, Abbott Cardiovascular, and Livanova. Dr Mack has served as a co-principal investigator for clinical trials for Abbott and Edwards Lifesciences; and has served as study chair for a trial for Medtronic; all roles were uncompensated. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.