Bacterial infiltration and bioprosthetic valve failure: Emerging diagnostics for emerging therapies

Profile (A) and inflow surface (B) of an explanted TAVR bioprosthesis with structural degeneration and endocarditis (reprinted with permission from Seeburger and colleagues 1 ). Despite the increasing use of bioprosthetic heart valves (BHV), the mechanisms underlying BHV failure remain elusive. It has been suggested that bacteria in explanted native valves from patients without clinical or laboratory evidence of infective endocarditis may contribute to structural valve degeneration (SVD). In this editorial we discuss the potential roles of infection and thrombosis in BHV SVD. The isolation of bacterial DNA from bioprosthetic heart valves (BHVs) is hypothesis-generating; however, there is inadequate evidence to conclude that bacterial infiltration contributes to BHV failure.