TAVR Durability at 5-10 Years

Study Questions:

What is the incidence of structural valve degeneration (SVD) 5-10 years after transcatheter aortic valve replacement (TAVR)?

Methods:

Demographic, procedural, and in-hospital outcome data on patients who underwent TAVR from 2007 to 2011 were obtained from the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) registry. Patients in whom echocardiographic data were available both at baseline and ≥5 years post-TAVR were included. Hemodynamic SVD was determined according to European task force committee guidelines.

Results:

A total of 241 patients (79.3 ± 7.5 years of age, 46% female) with paired post-procedure and late echocardiographic follow-up (median 5.8 years, range 5-10 years) were included in the analysis. A total of 149 patients (64%) were treated with a self-expandable valve and 80 (35%) with a balloon-expandable valve; in eight patients, the valve type was not specified. Median echocardiographic follow-up was 5.8 years (interquartile range, 5.3-7.7 years). Compared to 6 months post-procedure, peak gradient at follow-up was lower (17.1 vs. 19.1 mm Hg; p = 0.002), more patients had none/trivial aortic regurgitation (AR) (47.5% vs. 33%), and fewer had mild AR (42.5% vs. 57%; p = 0.02). There was one case (0.4%) of severe SVD 5.3 years after implantation (new severe AR). There were 21 cases (8.7%) of moderate SVD (mean 6.1 years post-implantation; range 4.9-8.6 years). Twelve of these (57%) were due to new AR and nine (43%) were due to prosthetic stenosis.

Conclusions:

The authors concluded that long-term transcatheter aortic valve function is excellent; with 91% of patients in this study remaining free of SVD between 5 and 10 years post-implantation, a <1% incidence of severe SVD, and 1 in 12 patients with moderate SVD.

Perspective:

There are good short- and moderate-term outcomes with TAVR. Perhaps the major factor limiting the use of TAVR in progressively lower-risk patients is unknown long-term durability. Specifically, if TAVR is to compete with surgical aortic valve replacement among younger patients at low risk, freedom from SVD should be acceptable through 10-20 years after implantation. Although truly long-term data are not yet available, data from this study and an accompanying study in this issue of the journal (Søndergaard F, et al., J Am Coll Cardiol 2019;73:546-53) suggest that freedom from SVD through about 5 years remains fairly good.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound

Keywords: Aortic Valve Insufficiency, Cardiac Surgical Procedures, Constriction, Pathologic, Coronary Stenosis, Diagnostic Imaging, Echocardiography, Heart Valve Diseases, Heart Valve Prosthesis, Hemodynamics, Transcatheter Aortic Valve Replacement


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