The VIVID (Valve-in-Valve International Data) group have published a standardised set of definitions for structural valve degeneration (SVD) of surgical and transcatheter aortic valve bioprostheses. They also make recommendations for the timing of clinical and imaging follow-up.

Dvir D, Bourguignon T, Otto CM, Hahn RT, Rosenhek R, Webb JG, et al. Standardized Definition of Structural Valve Degeneration for Surgical and Transcatheter Bioprosthetic Aortic Valves. Circulation. 2018 Jan 23;137(4):388–99.



  • An acquired intrinsic bioprosthetic valve abnormality defined as deterioration of the leaflets or supporting structures
  • Resulting in thickening, calcification, tearing, or disruption of the prosthetic valve materials with eventual associated valve hemodynamic dysfunction
  • Is caused by tissue disruption or thickening over time because of mechanical stress + abnormal flow shear stress
  • SVD does NOT include patient-prosthesis mismatch, device malposition, paravalvular regurgitation, & abnormal frame expansion
  • The process is usually gradual (over years) and so has been divided into stage

 Echocardiographic Assessment


Clinical Application

  • Routine post-procedural anticoagulation is currently a IIa recommendation for 3 months post SAVR
  • If a change in mean gradient > 10 mmHg or a clinical event (stroke, heart failure, decreased EF, new PVL) then 4D CT or TOE should be done
    • If leaflets are thickened should consider a trial of anticoagulation
  • All patients diagnosed with SVD should undergo a repeat TTE within 3 to 6 months to evaluate for rapid progression
  • For symptomatic patients with severe AR or AS, or moderate mixed AS/AR, should be considered for redo SAVR or valve-in-valve TAVR