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

Abstract

AbstractBackgroundWith expansion of transcatheter aortic valve implantation (TAVI) into younger patients, valve durability is critically important.AimsWe 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.MethodsData 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.Results221 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).ConclusionsHemodynamic 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.