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

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

TAVI

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