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Heart, Lung and Circulation

Long-Term Echocardiographic Follow-Up After Transcatheter Aortic Valve Implantation to Assess Structural Valve Deterioration and Bioprosthetic Valve Failure

Published:December 13, 2021DOI:https://doi.org/10.1016/j.hlc.2021.11.006

      Background

      Indications for transcatheter aortic valve implantation (TAVI) in aortic stenosis are expanding and the life expectancy of patients following TAVI is increasing. Determining the long-term durability of TAVI valves is therefore important. Rates of long-term (≥5 years) structural valve deterioration (SVD) vary widely and there are currently no comparable data from Australia. The aim herein was to determine the incidence of haemodynamic SVD and bioprosthetic valve failure (BVF) using recently standardised definitions in a Western Australian cohort after at least 5 years.

      Methods

      This is a retrospective cohort study of consecutive patients undergoing TAVI at Royal Perth Hospital between January 2009 and January 2015. Of 211 patients, 55 survived ≥5 years and had echocardiographic data available for review. Median time to the echocardiogram was 5.9 years (max 7.8 years); 49% male, mean age 83 years.

      Results

      Of the 55 survivors who had echocardiograms available ≥5 years after TAVI, four (9%) had moderate haemodynamic SVD and one (2%) had severe SVD and BVF.

      Conclusions

      Our results suggest excellent long-term durability of contemporary TAVI valves in an Australian cohort with very low incidence of SVD and BVF. These findings add confidence to the expanding applications of TAVI valves.

      Keywords

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      References

        • Baumgartner H.
        • Falk V.
        • Bax J.
        • De Bonis M.
        • Hamm C.
        • Holm P.
        • et al.
        2017 ESC/EACTS Guidelines for the management of valvular heart disease.
        Eur Heart J. 2017; 38: 2739-2791
        • Nishimura R.
        • Otto C.
        • Bonow R.
        • Carabello C.
        • Erwin J.
        • Fleisher L.
        • et al.
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        Circulation. 2017; 135: e1159-e1195
        • Siontis G.C.
        • Praz F.
        • Pilgrim T.
        • Mavridis D.
        • Verma S.
        • Salanti G.
        • et al.
        Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials.
        Eur Heart J. 2016; 37: 3503-3512
        • Mack M.
        • Leon M.
        • Thourani V.
        • Makkar R.
        • Kodali S.
        • Russo M.
        • et al.
        Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705
        • Mack M.
        • Leon M.
        • Smith C.
        • Miller D.
        • Moses J.
        • Tuzcu E.
        • et al.
        5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial.
        Lancet. 2015; 385: 2477-2484
        • Toggweiler S.
        • Humphries K.
        • Lee M.
        • Binder R.
        • Moss R.
        • Freeman M.
        • et al.
        5-year outcome after transcatheter aortic valve implantation.
        J Am Coll Cardiol. 2013; 61: 413-419
        • Barbanti M.
        • Petronio A.
        • Ettori F.
        • Latib A.
        • Bedogni F.
        • De Marco F.
        • et al.
        5-year outcomes after transcatheter aortic valve implantation with corevalve prosthesis.
        JACC Cardiovasc Interv. 2015; 8: 1084-1091
        • Muratori M.
        • Fusini L.
        • Tamborini G.
        • Gripari P.
        • Ghulam Ali S.
        • Mapelli M.
        • et al.
        Five-year echocardiographic follow-up after TAVI: structural and functional changes of a balloon-expandable prosthetic aortic valve.
        Eur Heart J Cardiovasc Imaging. 2017; 19: 389-397
        • Didier R.
        • Eltchaninoff H.
        • Donzeau-Gouge P.
        • Chevreul K.
        • Fajadet J.
        • Leprince P.
        • et al.
        Five-year clinical outcome and valve durability after transcatheter aortic valve replacement in high-risk patients.
        Circulation. 2018; 138: 2597-2607
        • Gleason T.
        • Reardon M.
        • Popma J.
        • Deeb M.
        • Yakubov S.
        • Lee J.
        • et al.
        5-year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients.
        J Am Coll Cardiol. 2018; 72: 2687-2696
        • Deutsh M.
        • Erlebach M.
        • Burri M.
        • Hapfelmeier A.
        • Witt O.
        • Ziegelmueller J.
        • et al.
        Beyond the five-year horizon: long-term outcome of high-risk and inoperable patients undergoing TAVR with first- generation devices.
        EuroIntervention. 2018; 14: 41-49
        • Holy E.W.
        • Kebernik J.
        • Abdelghani M.
        • Stämpfli S.
        • Hellermann J.
        • Allali A.
        • et al.
        Long-term durability and haemodynamic performance of a self-expanding transcatheter heart valve beyond five years after implantation: a prospective observational study applying the standardised definitions of structural deterioration and valve failure.
        EuroIntervention. 2018; 14: e390-96
        • Murray M.
        • Hoffman E.
        • Da Rosa R.
        • Mas-Peiro S.
        • Seppelt P.
        • Walther T.
        • et al.
        Hemodynamic outcome and valve durability beyond five years after transcatheter aortic valve replacement.
        J Invasive Cardiol. 2020; 32: 82-87
        • Blackman D.
        • Saraf S.
        • MacCarthy P.
        • Myat A.
        • Anderson S.
        • Malkin C.
        • et al.
        Long-term durability of transcatheter aortic valve prostheses.
        J Am Coll Cardiol. 2019; 73: 537-545
        • Dvir D.
        • Bourguignon T.
        • Otto C.
        • Hahn R.
        • Rosenhek R.
        • Webb J.
        • et al.
        Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves.
        Circulation. 2018; 137: 388-399
        • Capodanno D.
        • Petronio A.
        • Prendergast B.
        • Eltchaninoff H.
        • Vahanian A.
        • Modine T.
        • et al.
        Standardised definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: A consensus statement from The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2017; 38: 3382-3390
        • Barbanti M.
        • Webb J.
        • Tamburino C.
        • Van Mieghem N.
        • Makkar R.
        • Piazza N.
        • et al.
        Outcomes of redo transcatheter aortic valve replacement for the treatment of postprocedural and late occurrence of paravalvular regurgitation and transcatheter valve failure.
        Circ Cardiovasc Interv. 2016; 9: e003930
        • Eltchaninoff H.
        • Durand E.
        • Avinee G.
        • Tron C.
        • Litzler P.Y.
        • Bauer F.
        • et al.
        Assessment of structural valve deterioration of transcatheter aortic bioprosthetic balloon-expandable valves using the new European consensus definition.
        EuroIntervention. 2018; 14: 264-271
        • Barbanti M.
        • Costa G.
        • Zappulla P.
        • Todaro D.
        • Picci A.
        • Rapisarda G.
        • et al.
        Incidence of long-term structural valve dysfunction and bioprosthetic valve failure after transcatheter aortic valve replacement.
        J Am Heart Assoc. 2018; 7: e008440
        • Durand E.
        • Sokoloff A.
        • Urena-Alcazar M.
        • Chevalier B.
        • Chassaing S.
        • Didier R.
        • et al.
        Assessment of long-term structural deterioration of transcatheter aortic bioprosthetic valves using the new European definition: a multicentre French study.
        Circ Cardiovasc Interv. 2019; 12: e007597
        • Rodriguez-Gabella T.
        • Puri R.
        • Pibarot P.
        • Rodés-Cabau J.
        Aortic bioprosthetic valve durability.
        JACC. 2018; 70: 1013-1028
        • Abdel-Wahab M.
        • Mehilli J.
        • Frerker C.
        • Neumann F.
        • Kurz T.
        • El-Mawardy M.
        • et al.
        Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial.
        JAMA. 2014; 311: 1503-1514
        • Abdel-Wahab M.
        • Landt M.
        • Neumann F.
        • Massberg S.
        • Frerker C.
        • Kurz T.
        • et al.
        5-year outcomes after TAVR with balloon-expandable versus self-expanding valves; Results from the CHOICE randomized clinical trial.
        J Am Coll Cardiol Intv. 2020; 13: 1071-1082