Incidence and Predictors of Structural Valve Deterioration after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Abstract

Background. Transcatheter aortic valve replacement (TAVR), widely used as an alternative therapy in patients with severe aortic stenosis, is expected to be offered to low-risk patents with a longer life expectancy. The durability of transcatheter aortic valve is becoming of increasing importance. Method. PubMed, Embase, and Cochrane CENTRAL from the inception to March 2020 were systematically screened for studies reporting on structural valve deterioration (SVD) in TAVR patients. Incidence of SVD was diagnosed according to the latest European consensus as the primary end point. Predictors of SVD evaluated at multivariable analysis and cumulative incidence function (CIF) of SVD were the secondary end point. Result. Twelve studies encompassing 10031 patients evaluating the incidence of SVD were included, with a follow-up between 1 and 8 years. The pooled incidence of SVD was 4.93% (95% CI, 2.75%–7.70%, I2 = 96%) at 1 year and 8.97% (95% CI, 6.89%–11.29%, I2 = 86%) in the long term (≥5 years). Subgroup analysis was performed to identify the valve type that may result in partial heterogeneity. SVD was more frequent in patents with a valve diameter of <26 mm (HR: 3.57, 1.47–8.69), oral anticoagulants (OAC), exposure at discharge (OR: 0.48, 0.38–0.61), or by a disease of renal dysfunction (OR 1.42, 1.03–1.96). Conclusion. SVD represents infrequent events after TAVR in the long term (>5 years), occurring more commonly in renal dysfunction patients, with small valve diameter and without OAC exposure. There may be an underestimation of the incidence if we assume death as a competing risk.

Early structural valve deterioration of balloon expandable transcatheter aortic valve leaflets due to intrinsic and extrinsic nodular calcifications in a haemodialysis patient: a case report

“…The incidence of moderate or severe SVD is ∼8.97% at 5 years after TAVI, with no significant differences in the risk of developing SVD between TAVI and SAVR at the 5-year mark. 5 Notably, self-expanding TAVI had a significantly larger EOA and lower mAVPG in echocardiograms than balloon-expandable TAV and SAVR (1.84 ± 0.54 vs. 1.51 ± 0.49 vs. 1.39 ± 0.45, P < 0.01; 7.42 ± 3.60 vs. 11.61 ± 6.65 vs. 11.33 ± 5.39, P < 0.01). 6 However, reports are lacking on the long-term procedural outcomes of TAVI in haemodialysis patients.…”

Transcatheter aortic valve replacement: Past, present, and future

“…Although patients with a high life expectancy are usually offered surgery instead of TAVR due to concerns about durability, a significant number of TAVR patients still experience these complications during their lifetime. For example, a meta‐analysis found that the pooled incidence of structural valve deterioration in TAVR patients at 1 year was 4.93% 88 . Given that the indications for TAVR are being expanded further to low‐risk patients with a longer life expectancy, 13,14 bioprosthetic valve failure could soon become a much bigger issue.…”

“…For example, a meta‐analysis found that the pooled incidence of structural valve deterioration in TAVR patients at 1 year was 4.93%. 88 Given that the indications for TAVR are being expanded further to low‐risk patients with a longer life expectancy, 13 , 14 bioprosthetic valve failure could soon become a much bigger issue.…”