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. 2023 Apr;101(5):932-942.
doi: 10.1002/ccd.30627. Epub 2023 Mar 15.

Long-term durability of self-expanding and balloon-expandable transcatheter aortic valve prostheses: UK TAVI registry

Noman Ali  1 , David Hildick-Smith  2 , Jessica Parker  2 , Christopher J Malkin  1 , Michael S Cunnington  1 , Shuslim Gurung  1 , Jonathan Mailey  3 , Philip A MacCarthy  4 , Apurva Bharucha  4 , Stephen J Brecker  5 , Stephen P Hoole  6 , Stephen Dorman  7 , Sagar N Doshi  8 , Andrew Wiper  9 , Mamta H Buch  10 , Adrian P Banning  11 , Mark S Spence  3 , Daniel J Blackman  1
Affiliations

Long-term durability of self-expanding and balloon-expandable transcatheter aortic valve prostheses: UK TAVI registry

Noman Ali et al. Catheter Cardiovasc Interv. 2023 Apr.

Abstract

Background: With expansion of transcatheter aortic valve implantation (TAVI) into younger patients, valve durability is critically important.

Aims: We aimed to evaluate long-term valve function and incidence of severe structural valve deterioration (SVD) among patients ≥ 10-years post-TAVI and with echocardiographic follow-up at least 5-years postprocedure.

Methods: Data on patients who underwent TAVI from 2007 to 2011 were obtained from the UK TAVI registry. Patients with paired echocardiograms postprocedure and ≥5-years post-TAVI were included. Severe SVD was determined according to European task force guidelines.

Results: 221 patients (79.4 ± 7.3 years; 53% male) were included with median echocardiographic follow-up 7.0 years (range 5-13 years). Follow-up exceeded 10 years in 43 patients (19.5%). Valve types were the supra-annular self-expanding CoreValve (SEV; n = 143, 67%), balloon-expandable SAPIEN/XT (BEV; n = 67, 31%), Portico (n = 4, 5%) and unknown (n = 7, 3%). There was no difference between postprocedure and follow-up peak gradient in the overall cohort (19.3 vs. 18.4 mmHg; p = NS) or in those with ≥10-years follow-up (21.1 vs. 21.1 mmHg; p = NS). Severe SVD occurred in 13 patients (5.9%; median 7.8-years post-TAVI). Three cases (23.1%) were due to regurgitation and 10 (76.9%) to stenosis. Valve-related reintervention/death occurred in 5 patients (2.3%). Severe SVD was more frequent with BEV than SEV (11.9% vs. 3.5%; p = 0.02), driven by a difference in patients treated with small valves (BEV 28.6% vs. SEV 3.0%; p < 0.01).

Conclusions: Hemodynamic function of transcatheter heart valves remains stable up to more than 10 years post-TAVI. Severe SVD occurred in 5.9%, and valve-related death/reintervention in 2.3%. Severe SVD was more common with BEV than SEV.

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

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Comment in

  • TAVR for all-Is it time?
    Mustafa U, Helmy T. Mustafa U, et al. Catheter Cardiovasc Interv. 2023 May;101(6):1174-1175. doi: 10.1002/ccd.30665. Epub 2023 Apr 25. Catheter Cardiovasc Interv. 2023. PMID: 37096934 No abstract available.

References

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