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Table 6 Follow-up: prosthetic valve replacement, valve repair and aorta*

From: Clinical indications and triaging for adult transthoracic echocardiography: a statement by the British Society of Echocardiography

Valve replacement/repair

Mechanical valve replacement

Biological valve replacement (surgical)

Mitral valve repair (surgical)

• Baseline (4–6 weeks post operatively)

• If baseline TTE normal and no alerts (see below), no routine surveillance

• If regurgitation review by native valve criteria; consider TOE

• Baseline (4–6 weeks post operatively)

• MV/TV or AV < 60 years (unless alerts, see below): Annual TTE from 5 years post implant (for new valve with no durability data annual from implantation)

• AV > 60 years and AV with proven longevity: Annual surveillance TTE from 10 years post implant (unless alerts, see below)

If regurgitation review by native valve criteria

• Competent: Baseline (4–6 weeks post operatively), 1 year post op, then every 2–3 years

• Incompetent: Individualised plan

Alerts for TTE/ Cardiologist review:

• New or worsening prosthetic valve regurgitation

• Gradient/effective orifice area outside of expected parameters

• New LV dilatation or LV systolic dysfunction

• Aortic root dilatation. Urgent if ≥ 45 mm in Marfan syndrome; ≥ 50 mm in bicuspid aortic valve; ≥ 55 mm for all other patients

• Suggestion of infective endocarditis or previously medically treated prosthetic valve endocarditis

• Worsening symptoms or other sonographer concerns

Aortic valve and aortic root replacement

Aortic root surveillance post bicuspid aortic valve surgery

• Ongoing assessment of the aortic root: individualised plan based on clinical, anatomical and surgical features

• Reasonable default: 2 yearly cross sectional imaging

• If normal diameter by TTE, then TTE every 3–5 years

• If aortic dilatation: individualised plan based on degree of dilatation and rate of progression on sequential TTE

• If dilatation on TTE not reproducible with cCT/cMRI (> 2 mm difference): interval imaging with cCT or MRI


Mitral valve repair (transcatheter)

• Baseline (4–6 weeks post operatively) or as directed by operator, then annular surveillance. If stable then increase TTE surveillance to 2 years

• If paravalvular/transvalvular regurgitation review by native valve criteria

• If other native valve stenosis/regurgitation, review by native valve criteria

• Complex cases with LV dysfunction or multi-native valve disease: individualised plan

• Competent: Baseline (4–6 weeks post operatively), then annually

• Incompetent: individualised plan

  1. AV (aortic valve), cCT (cardiac computer tomography), cMRI (cardiac magnetic resonance), LV (left ventricular), mm (millimetres), MV (mitral valve), TAVI (transcatheter aortic valve implantation), TTE (transthoracic echocardiography), TV (tricuspid valve), TOE (trans-oesophageal echocardiography)
  2. *Adapted from Chambers et al. 2019 [15] and Borger et al. 2018 [16]