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Heart, Lung and Circulation

Long-Term Valve Durability in Patients Undergoing Transcatheter Aortic Valve Implantation

Published:November 11, 2022DOI:https://doi.org/10.1016/j.hlc.2022.10.006

      Aims

      To evaluate the long-term incidence of structural valve deterioration (SVD) in patients who underwent transcatheter aortic valve implantation (TAVI).

      Method and Results

      Between 2008 and 2018, 693 underwent TAVI at two centres. Four hundred and twenty-one (421) patients (mean age 83.6±6.0 yrs) survived for ≥2 years post TAVI and had at least two consecutive transthoracic echocardiographies (TTEs) with the latest TTE no less than 2 years after TAVI, and were therefore included in the analysis for SVD. Median follow-up was 4.7 (3.6–6.0) years and median echocardiography follow-up 3 (3.0–4.0) years. All-cause mortality was 30.9% (130) with a median time to death of 4.1 (3.0–5.6) years. The cumulative incidence of SVD increased from 1.7% (95% CI, 0.4–2.9) at 3 years to 3.5% (95% CI, 1.5–5.8) at 5 years and 4.7% (95% CI, 1.6–7.9) at 10 years. The overall median time to SVD was 3 (2–4) years.
      Twelve (12) patients demonstrated SVD stage 2, and 1 patient stage 3. No SVD required re-intervention. All other patients showed no significant changes in valve parameters over time.

      Conclusions

      Structural valve deterioration is an uncommon event, occurring in 5% over a total follow-up of 10 years. Most patients show stable valve parameters. However, the analysis is limited by the loss of follow-up (owing to patient mortality), which renders extrapolation of the data to a younger patient population difficult.

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