Transcatheter Aortic Valve Implantation: Long-Term Outcomes and Durability

Abstract

Transcatheter aortic valve implantation (TAVI) has become the standard of care in symptomatic older patients with severe aortic stenosis regardless of surgical risk. With the development of newer generation transcatheter bioprostheses, improved delivery systems, better preprocedure planning with imaging guidance, increased operator experience, shorter hospital length of stay, and low short- and mid-term complication rates, TAVI is gaining popularity among younger patients at low or intermediate surgical risk. Long-term outcomes and durability of transcatheter heart valves have become substantially important for this younger population due to their longer life expectancy. The lack of standardized definitions of bioprosthetic valve dysfunction and disagreement about how to account for the competing risks made comparison of transcatheter heart valves with surgical bioprostheses challenging until recently. In this review, the authors discuss the mid- to long-term (≥ 5 years) clinical outcomes observed in the landmark TAVI trials and analyze the available long-term durability data emphasizing the importance of using standardized definitions of bioprosthetic valve dysfunction.

Keywords: durability; long-term outcomes; severe aortic valve stenosis; structural valve degeneration; surgical aortic valve replacement; transcatheter aortic valve implantation.

Figure 1

Five-year cumulative incidence rate of structural valve degeneration (SVD) in patients randomized to surgery or transcatheter aortic valve replacement (TAVI) from post hoc analysis pooled data from the CoreValve US High Risk Pivotal (n = 615) and SURTAVI (n = 1484) randomized clinical trials (RCTs). Reproduced with permission from JAMA Cardiol. Copyright©2023 American Medical Association. All rights reserved.