Abstract

Early Bioprosthetic Valve Failure (EBVF)-defined as valve dysfunction necessitating reintervention, causing severe haemodynamic compromise, or death within five years of implantation-is an increasingly recognized clinical syndrome of growing importance as Bioprosthetic Heart Valves (BHVs) are extended to younger, lower-risk populations. Unlike late Structural Valve Degeneration (SVD), EBVF encompasses a spectrum of distinct mechanisms including accelerated calcification, immune-mediated SVD, bioprosthetic valve thrombosis, Prosthetic Valve Endocarditis (PVE) and prosthesis-patient mismatch. The temporal phase of failure provides critical diagnostic guidance: procedural and anatomical causes dominate within 30 days, infective and thrombotic mechanisms predominate within the first year and accelerated structural degeneration emerges thereafter. A multimodality diagnostic strategy integrating transthoracic and transesophageal echocardiography, cardiac computed tomography, cardiac magnetic resonance and nuclear imaging (18F-FDG PET/CT) is essential. Treatment is mechanism-directed and planning for reintervention- whether redo surgery or transcatheter Valve-In-Valve (ViV)-must incorporate lifetime valve management strategy, including future re-intervention feasibility. Anti-calcification tissue platforms, decellularized xenograft scaffolds and immune biomarker surveillance offer the prospect of earlier identification and risk-stratified follow-up. Systematic identification of EBVF and structured heart team decision-making are essential as the global BHV population expands.