Assessment of long-term structural deterioration of transcatheter aortic bioprosthetic valves

Background The durability of transcatheter aortic bioprosthetic valves is a crucial issue in the context of extension of indications in younger and lower-risk patients, but data are scarce, especially beyond 5 years of follow-up. Purpose The aim of this study was to evaluate the incidence of structural valve degeneration (SVD). Methods Demographic, procedural, and in-hospital outcome data on patients who underwent transcatheter aortic valve implantation (TAVI) from 2002 to 2020 were obtained from our prospective institutional database. Patients in whom echocardiographic data were available both at baseline and follow-up post-TAVI were included. Clinical and echocardiographic follow-up were performed on site annually. Hemodynamic SVD was determined according to European task force committee guidelines. Results A total of 1824 patients (83.6 ± 6.8 years of age; 53% female) with paired post-procedure and late echocardiographic follow-up (median 1.9 years, max 10.9 years) were included. Among them, 223 (12.3%) patients have a follow-up of more than 5 years. A self-expandable valve was used in 160 (8.8%) patients while the remaining patients were treated with, a balloon-expandable valve (91.2%). Mean aortic gradient and effective aortic valve area remained unchanged during follow-up. SVD occurred in 16 (0.9%) patients. SVD was moderate in 8 (0.4%) patients and severe in 8 (0.4%) patients. Four (0.4%) patients required redo-TAVI for severe SVD. Conclusions Our data do not demonstrate any alarm signal on transcatheter aortic valve durability. Careful prospective assessment in younger and lower risk patients and comparison with surgical bioprosthetic valves are required to further assess long-term durability of transcatheter valves.