Background

As transcatheter aortic valve implantation (TAVI) is being offered to younger, lower-risk patients with longer life expectancy, lifetime management requires an understanding of bioprosthetic valve durability of transcatheter aortic heart valves (THV).

Aim

To investigate the incidence, predictors and clinical impact of bioprosthetic structural valve deterioration (SVD) during extended follow-up at five years after TAVI with either balloon-expandable or self-expanding transcatheter heart valves.

Methods

In this single-center study, we included consecutive patients undergoing TAVI between 01/2014 and 08/2017. Hemodynamic SVD after TAVI was defined according to Valve Academic Research Consortium (VARC)-3 criteria, using echocardiographic data from discharge echo after TAVI to last available echo during follow-up. Patients undergoing valve-in-valve TAVI procedures, implantation of multiple valves at the index procedure, in-hospital death, missing echo data in-hospital and device failure due to elevated transprosthetic gradients ≥20 mmHg after TAVI were excluded. We examined the incidence of SVD and the association of SVD with a composite endpoint of all-cause death, repeat procedure and re-hospitalization for heart failure.

Results

A total of 922 patients were included. The median follow-up was 858 days. SVD was observed in 6,6% of all patients, moderate SVD in 5,7% of all patients and severe SVD in 0,9% of all patients. A higher mean transvalvular gradient pre-procedure was associated with a higher risk for SVD. Three quarters of all patients received balloon-expandable valves, whereas one quarter was treated with self-expanding valves. The patients with self-expanding valves tended to show a lower incidence of SVD (5,2% vs. 8,4% of patients with balloon-expandable valves). The composite endpoint occurred in 43,2% of all patients and was numerically higher in patients without the diagnosis of SVD without reaching statistical significance (44,1% vs. 32,9%; p=0.068).

Conclusion

In patients with severe aortic stenosis undergoing TAVI, the incidence of moderate or severe hemodynamic SVD after TAVI is overall low during extended follow-up at 5 years. Implantation of self-expanding valves seems to be associated with a lower incidence of hemodynamic SVD after TAVI. Event rates were overall high in this cohort of elderly patients and did not seem to be increased by SVD.