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. 2023 Sep 3;12(17):5740. doi: 10.3390/jcm12175740

Table 2.

Stages of structural valve degeneration. The impairment of prosthetic aortic and mitral valves hemodynamic is associated with abnormal echocardiographic parameters for each stage. DVI for aortic prosthesis is calculated as LVOT VTI/aortic VTI; DVI for mitral prosthesis is calculated as mitral VTI/LVOT VTI. AT, acceleration time; DVI, Doppler velocity index; EOA, effective orifice area; ET, ejection time; MVA, mitral valve area; LVOT, left ventricular outflow tract; V max, maximum velocity; SVD, structural valve degeneration; VTI, velocity time integral.

SVD Stages Aortic Valve Bioprosthesis Mitral Valve Bioprosthesis
Stage 1 Morphological valve deterioration without hemodynamic impairment. Morphological valve deterioration without hemodynamic impairment.
Vmax: <3 m/s;
Mean gradient < 20 mmHg, with an increase in mean gradient during follow-up < 10 mmHg;
DVI > 0.35;
AT < 100 ms;
AT/ET < 0.32;
EOA > 1.2 cm2 for BSA < 1.6 m2;
EOA > 1 cm2 for BSA < 1.6 m2.		 Mean gradient < 5 mmHg;
DVI < 0.4;
MVA > 1.5 cm2.
Stage 2 Morphological valve deterioration plus one of the following: Morphological valve deterioration plus one of the following:
Vmax: 3–4 m/s;
Mean gradient: 20–40 mmHg, with an increase in mean gradient during follow-up between 10 and 20 mmHg;
DVI between 0.25 and 0.35;
AT between 80 and 100 ms;
AT/ET between 0.32 and 0.37;
EOA between 1 and 1.2 cm2 for BSA < 1.6 m2;
EOA between 0.8 and 1.1 cm2 for BSA > 1.6 m2;
Moderate regurgitation.		 Increase in DVI ≥ 0.4 or ≥20% resulting in DVI ≥ 2.2;
Decrease in MVA ≥ 0.5 cm2 or ≥25% resulting in MVA < 1.5 cm2, compared with echocardiographic assessment performed post-surgery;
Mean gradient > 5 mmHg;
Moderate regurgitation.
Stage 3 Morphological valve deterioration plus one of the following: Morphological valve deterioration plus one of the following:
Vmax > 4 m/s;
Mean gradient > 40 mmHg, with an increase in mean gradient > 20 mmHg during follow-up;
AT > 100 ms;
AT/ET > 0.37;
EOA < 1 cm2 for BSA < 1.6 m2;
EOA < 0.8 cm2 for BSA > 1.6 m2.
Severe regurgitation		 Increase in DVI ≥ 0.8 or ≥ 40% resulting in DVI ≥ 2.5;
Decrease in MVA ≥ 1.0 cm2 or ≥50% resulting in MVA < 1.0 cm2, compared to echocardiographic assessment performed post-surgery;
Mean gradient > 10 mm Hg during follow-up;
Severe regurgitation.