Transcatheter Aortic Valve Implantation: Long-Term Outcomes and Durability

Abstract

Transcatheter aortic valve implantation (TAVI) has become the standard of care in symptomatic older patients with severe aortic stenosis regardless of surgical risk. With the development of newer generation transcatheter bioprostheses, improved delivery systems, better preprocedure planning with imaging guidance, increased operator experience, shorter hospital length of stay, and low short-and mid-term complication rates, TAVI is gaining popularity among younger patients at low or intermediate surgical risk. Longterm outcomes and durability of transcatheter heart valves have become substantially important for this younger population due to their longer life expectancy. The lack of standardized definitions of bioprosthetic valve dysfunction and disagreement about how to account for the competing risks made comparison of transcatheter heart valves with surgical bioprostheses challenging until recently. In this review, the authors discuss the mid-to long-term (≥ 5 years) clinical outcomes observed in the landmark TAVI trials and analyze the available long-term durability data emphasizing the importance of using standardized definitions of bioprosthetic valve dysfunction.

Incorporating Redo-TAVR Feasibility Into Lifelong Aortic Valve Management

“…However, analyses of long-term outcomes from early TAVR trials suggest increased rates of paravalvular regurgitation, structural valve degeneration, and valve reintervention, as compared with surgically implanted valves, in intermediate- and high-risk cohorts. 2 More recent analysis of self-expanding supra-annular CoreValve/Evolut suggest a decreased incidence of structural valve degeneration with TAVR compared with surgical aortic valve replacement (SAVR) at 5 years, 3 which was further supported by the 10-year NOTION (Nordic Aortic Valve Intervention) data recently presented showing lower rates of structural valve degeneration with CoreValve compared with surgery. We anxiously await the 5-year PARTNER III (Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis) data to understand if intra-annular balloon-expandable SAPIEN valves perform as well.…”