Long-term durability of transcatheter aortic valve prostheses

Background: Very little is known about long-term valve durability after trans-catheter aortic valve implantation (TAVI). Objectives: To evaluate the incidence of structural valve degeneration 5 to 10 years post procedure. Methods: Demographic, procedural, and in-hospital outcome data on patients who underwent TAVI from 2007-2011 were obtained from the UK TAVI Registry. Patients in whom echocardiographic data were available both at baseline and =5 years post-TAVI were included. Haemodynamic structural valve degeneration (SVD) was determined according to European task force committee guidelines. Results: 241 patients (79.3±7.5 years; 46.4% female) with paired post-procedure and late echocardiographic follow-up (median 5.8 years, range 5 - 10 years) were included. 150 patients (64.1%) were treated with a CoreValve and 80 (34.2%) with an Edwards valve. Peak aortic valve gradient at follow-up was lower than post-procedure (17.2 vs 19.4 mmHg, p=0.003). More patients had none/trivial aortic regurgitation (AR) at follow-up (47.4% vs 32.9%, p=0.055), and fewer had mild AR (41.7% vs 57.7%, p=0.02). There was 1 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). 12 of these (57%) were due to new AR and 9 (43%) to restenosis. 4 Conclusions: Long-term transcatheter aortic valve function is excellent. In our study, 91% of patients remained free of structural valve deterioration between 5 and 10 years post-implantation. The incidence of severe structural valve degeneration was less than 1%. Moderate structural valve degeneration occurred in one in twelve patients.