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Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long\u2010term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.<\/jats:p>","DOI":"10.1161\/jaha.120.018506","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T05:24:17Z","timestamp":1600665857000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":319,"title":["Degeneration of Bioprosthetic Heart Valves: Update 2020"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6099-0315","authenticated-orcid":false,"given":"Alexander E.","family":"Kostyunin","sequence":"first","affiliation":[{"name":"Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian 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