Heart, Lung and Circulation

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

Published:November 11, 2022DOI:


      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.


      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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        • Lung B A.V.
        Epidemiology of valvular heart disease in the adult.
        Nat Rev Cardiol. 2011; 8: 162-172
        • Nkoma V.T.
        • Gardin J.M.
        • Skelton T.N.
        • Gottdiener J.S.
        • Scott C.G.
        • M E-S
        Burden of valvular heart diseases: a population-based study.
        Lancet. 2006; 368: 1005-1011
        • Mack M.J.
        • Leon M.B.
        • Thourani V.H.
        • Makkar R.
        • Kodali S.K.
        • 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
        • Popma J.J.
        • Deeb G.M.
        • Yakubov S.J.
        • Mumtaz M.
        • Gada H.
        • O'Hair D.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.
        N Engl J Med. 2019; 380: 1706-1715
      1. FDA expands indication for several transcatheter heart valves to patients at low risk for death or major complications associated with open-heart surgery.
        (last accessed 07/18/2021)
        • Sondergaard L.
        • Ihlemann N.
        • Capodanno D.
        • Jorgensen T.H.
        • Nissen H.
        • Kjeldsen B.J.
        • et al.
        Durability of transcatheter and surgical bioprosthetic aortic valves in patients at lower surgical risk.
        J Am Coll Cardiol. 2019; 73: 546-553
        • Makkar R.R.
        • Thourani V.H.
        • Mack M.J.
        • Kodali S.K.
        • Kapadia S.
        • Webb J.G.
        • et al.
        Five-year outcomes of transcatheter or surgical aortic-valve replacement.
        N Engl J Med. 2020; 382: 799-809
        • Dvir D.
        • Bourguignon T.
        • Otto C.M.
        • Hahn R.T.
        • Rosenhek R.
        • Webb J.G.
        • et al.
        Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves.
        Circulation. 2018; 137: 388-399
        • Capodanno D.
        • Petronio A.S.
        • Prendergast B.
        • Eltchaninoff H.
        • Vahanian A.
        • Modine T.
        • et al.
        Standardized 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
        • Blackman D.J.
        • Saraf S.
        • MacCarthy P.A.
        • Myat A.
        • Anderson S.G.
        • Malkin C.J.
        • et al.
        Long-term durability of transcatheter aortic valve prostheses.
        J Am Coll Cardiol. 2019; 73: 537-545
        • 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.
        Circ Cardiovasc Interv. 2019; 12e007597
        • 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: e264-e271
        • Holy E.W.
        • Kebernik J.
        • Abdelghani M.
        • Stämpfli S.F.
        • 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-e396
        • 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; 7e008440
        • 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
        • Stehli J.
        • Koh J.Q.S.
        • Duffy S.J.
        • Zamani J.
        • Yeong C.C.
        • Paratz E.
        • et al.
        Comparison of outcomes of transcatheter aortic valve implantation in patients aged >90 years versus <90 years.
        Am J Cardiol. 2019; 124: 1085-1090
        • Stehli J.
        • Dagan M.
        • Zaman S.
        • Koh J.Q.S.
        • Quine E.
        • Gouskova N.
        • et al.
        Impact of gender on transcatheter aortic valve implantation outcomes.
        Am J Cardiol. 2020; 133: 98-104
        • Head S.J.
        • Mokhles M.M.
        • Osnabrugge R.L.
        • Pibarot P.
        • Mack M.J.
        • Takkenberg J.J.
        • et al.
        The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years.
        Eur Heart J. 2012; 33: 1518-1529
        • Rheude T.
        • Pellegrini C.
        • Cassese S.
        • Wiebe J.
        • Wagner S.
        • Trenkwalder T.
        • et al.
        Predictors of haemodynamic structural valve deterioration following transcatheter aortic valve implantation with latest-generation balloon-expandable valves.
        EuroIntervention. 2020; 15: 1233-1239
        • Abdel-Wahab M.
        • Landt M.
        • Neumann F.J.
        • 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.
        JACC Cardiovasc Interv. 2020; 13: 1071-1082