Figure 1 Causes of bioprosthetic valve dysfunction.

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Figure 1 Causes of bioprosthetic valve dysfunction. From: Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. Published online July 21, 2017. doi:10.1093/eurheartj/ehx303 Eur Heart J | The article has been co-published with permission in the European Heart Journal (doi: 10.1093/eurheartj/ehx303) on behalf of the European Society of Cardiology and European Journal of Cardio-Thoracic Surgery (doi: 10.1093/ejcts/ezx244) on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved in respect of the European Heart Journal and European Journal of Cardio-Thoracic Surgery. © The Authors 2017. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. European Heart Journal requests that authors cite this article as follows: Davide Capodanno, Anna Sonia Petronio, Bernard Prendergast, Helene Eltchaninoff, Alec Vahanian, Thomas Modine, Patrizio Lancellotti, Lars Sondergaard, Peter F Ludman, Corrado Tamburino, Nicolò Piazza, Jane Hancock, Julinda Mehilli, Robert Byrne, Andreas Baumbach, Arie Pieter Kappetein, Stephan Windecker, Jeroen Bax, Michael Haude; Standardised Definitions of Structural Deterioration and Valve Failure in Assessing Long-Term Durability of Transcatheter and Surgical Aortic Bioprosthetic Valves: A Consensus Statement from The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2017 ehx303. doi: 10.1093/eurheartj/ehx303. For permissions, please email journals.permissions@oup.com.

Figure 2 Suggested management algorithm at echocardiographic follow-up Figure 2 Suggested management algorithm at echocardiographic follow-up. HD, haemodynamic dysfunction; MDCT, multi-detector computed tomography; SVD, structural valve deterioration; TOE, transoesophageal echocardiography; TTE, transthoracic echocardiography; VHD, valvular heart disease. From: Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. Published online July 21, 2017. doi:10.1093/eurheartj/ehx303 Eur Heart J | The article has been co-published with permission in the European Heart Journal (doi: 10.1093/eurheartj/ehx303) on behalf of the European Society of Cardiology and European Journal of Cardio-Thoracic Surgery (doi: 10.1093/ejcts/ezx244) on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved in respect of the European Heart Journal and European Journal of Cardio-Thoracic Surgery. © The Authors 2017. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. European Heart Journal requests that authors cite this article as follows: Davide Capodanno, Anna Sonia Petronio, Bernard Prendergast, Helene Eltchaninoff, Alec Vahanian, Thomas Modine, Patrizio Lancellotti, Lars Sondergaard, Peter F Ludman, Corrado Tamburino, Nicolò Piazza, Jane Hancock, Julinda Mehilli, Robert Byrne, Andreas Baumbach, Arie Pieter Kappetein, Stephan Windecker, Jeroen Bax, Michael Haude; Standardised Definitions of Structural Deterioration and Valve Failure in Assessing Long-Term Durability of Transcatheter and Surgical Aortic Bioprosthetic Valves: A Consensus Statement from The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2017 ehx303. doi: 10.1093/eurheartj/ehx303. For permissions, please email journals.permissions@oup.com.

Figure 3 Suggested assessment of bioprosthetic valve failure (BVF) in outcome studies of transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). SVD, structural valve deterioration. From: Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. Published online July 21, 2017. doi:10.1093/eurheartj/ehx303 Eur Heart J | The article has been co-published with permission in the European Heart Journal (doi: 10.1093/eurheartj/ehx303) on behalf of the European Society of Cardiology and European Journal of Cardio-Thoracic Surgery (doi: 10.1093/ejcts/ezx244) on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved in respect of the European Heart Journal and European Journal of Cardio-Thoracic Surgery. © The Authors 2017. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. European Heart Journal requests that authors cite this article as follows: Davide Capodanno, Anna Sonia Petronio, Bernard Prendergast, Helene Eltchaninoff, Alec Vahanian, Thomas Modine, Patrizio Lancellotti, Lars Sondergaard, Peter F Ludman, Corrado Tamburino, Nicolò Piazza, Jane Hancock, Julinda Mehilli, Robert Byrne, Andreas Baumbach, Arie Pieter Kappetein, Stephan Windecker, Jeroen Bax, Michael Haude; Standardised Definitions of Structural Deterioration and Valve Failure in Assessing Long-Term Durability of Transcatheter and Surgical Aortic Bioprosthetic Valves: A Consensus Statement from The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2017 ehx303. doi: 10.1093/eurheartj/ehx303. For permissions, please email journals.permissions@oup.com.

Figure 4 Schematic representation of the effect of using actual vs Figure 4 Schematic representation of the effect of using actual vs. actuarial analyses for assessment of bioprosthetic valve failure (BVF) in studies of transcatheter aortic valve implantation (TAVI) durability. (A) Case example of 20 TAVI patients with 20-year follow-up (FU), where 5 patients experience BVF and 15 patients die, with all BVFs occurring before any death. The actual and actuarial estimates of BVF coincide. (B) Alternative scenario where 15 patients die and 5 patients experience BVF, with all deaths occurring before any BVF (i.e. competing risk). The actuarial analysis provides a higher estimate of BVF than the actual analysis. From: Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. Published online July 21, 2017. doi:10.1093/eurheartj/ehx303 Eur Heart J | The article has been co-published with permission in the European Heart Journal (doi: 10.1093/eurheartj/ehx303) on behalf of the European Society of Cardiology and European Journal of Cardio-Thoracic Surgery (doi: 10.1093/ejcts/ezx244) on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved in respect of the European Heart Journal and European Journal of Cardio-Thoracic Surgery. © The Authors 2017. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. European Heart Journal requests that authors cite this article as follows: Davide Capodanno, Anna Sonia Petronio, Bernard Prendergast, Helene Eltchaninoff, Alec Vahanian, Thomas Modine, Patrizio Lancellotti, Lars Sondergaard, Peter F Ludman, Corrado Tamburino, Nicolò Piazza, Jane Hancock, Julinda Mehilli, Robert Byrne, Andreas Baumbach, Arie Pieter Kappetein, Stephan Windecker, Jeroen Bax, Michael Haude; Standardised Definitions of Structural Deterioration and Valve Failure in Assessing Long-Term Durability of Transcatheter and Surgical Aortic Bioprosthetic Valves: A Consensus Statement from The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2017 ehx303. doi: 10.1093/eurheartj/ehx303. For permissions, please email journals.permissions@oup.com.