Long-Term Durability of Transcatheter Aortic Valve Prostheses

J Am Coll Cardiol. 2019 Feb 12;73(5):537-545. doi: 10.1016/j.jacc.2018.10.078.

Abstract

Background: Very little is known about long-term valve durability after transcatheter aortic valve replacement (TAVR).

Objectives: This study sought to evaluate the incidence of structural valve degeneration (SVD) 5 to 10 years post-procedure.

Methods: Demographic, procedural, and in-hospital outcome data on patients who underwent TAVR from 2007 to 2011 were obtained from the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) registry. Patients in whom echocardiographic data were available both at baseline and ≥5 years post-TAVR were included. Hemodynamic SVD was determined according to European task force committee guidelines.

Results: A total of 241 patients (79.3 ± 7.5 years of age; 46% female) with paired post-procedure and late echocardiographic follow-up (median 5.8 years, range 5 to 10 years) were included. A total of 149 patients (64%) were treated with a self-expandable valve and 80 (34.7%) with a balloon-expandable valve. Peak aortic valve gradient at follow-up was lower than post-procedure (17.1 vs. 19.1 mm Hg; p = 0.002). More patients had none/trivial aortic regurgitation (AR) (47.5% vs. 33%), and fewer had mild AR (42.5% vs. 57%) at follow-up (p = 0.02). There was 1 case (0.4%) of severe SVD 5.3 years after implantation (new severe AR). There were 21 cases (8.7%) of moderate SVD (mean 6.1 years post-implantation; range 4.9 to 8.6 years). Twelve of these (57%) were due to new AR and 9 (43%) to restenosis.

Conclusions: Long-term transcatheter aortic valve function is excellent. In the authors' study, 91% of patients remained free of SVD between 5 and 10 years post-implantation. The incidence of severe SVD was <1%. Moderate SVD occurred in 1 in 12 patients.

Keywords: structural valve degeneration; transcatheter aortic valve replacement; valve durability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Insufficiency* / diagnosis
  • Aortic Valve Insufficiency* / epidemiology
  • Aortic Valve Insufficiency* / etiology
  • Aortic Valve Stenosis* / epidemiology
  • Aortic Valve Stenosis* / surgery
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / physiopathology
  • Aortic Valve* / surgery
  • Echocardiography / methods
  • Female
  • Heart Valve Prosthesis*
  • Hemodynamics
  • Humans
  • Long Term Adverse Effects / diagnosis
  • Long Term Adverse Effects / epidemiology
  • Male
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Prosthesis Design
  • Prosthesis Failure
  • Transcatheter Aortic Valve Replacement / adverse effects*
  • Transcatheter Aortic Valve Replacement / instrumentation
  • Transcatheter Aortic Valve Replacement / methods
  • United Kingdom / epidemiology