Evidence base: current data on TAVI durability and long-term outcomes

Durability beyond a single endpoint

Transcatheter aortic valve implantation (TAVI) has moved from a therapy for elderly and high-risk patients to a standard treatment option across much broader patient populations. As indications expand to younger and lower-risk patients, durability has become one of the central questions in contemporary structural heart disease care¹.

Importantly, durability should not be reduced to a single number of years. It is better understood as a combination of structural valve deterioration, non-structural valve dysfunction, thrombosis, endocarditis, need for reintervention, and the feasibility of lifetime management if failure occurs later. This broader framework is now well captured by the VARC-3 definitions, which have improved the consistency of durability reporting across trials and registries.

What current data tells us

Overall, the message from current evidence is reassuring. Contemporary TAVI demonstrates strong midterm durability, with low rates of structural valve deterioration and bioprosthetic valve failure through five to ten years in the datasets currently available.

At the same time, the field is entering a more nuanced phase. The key question is no longer whether TAVI valves can last several years, but rather how durability differs by platform, patient age, anatomy, implantation strategy, and lifetime treatment sequencing.

Evidence from randomised trials

Among balloon-expandable platforms, the PARTNER 3 trial remains one of the most important datasets in low-risk patients. Five-year published results showed that TAVR and SAVR had similar valve durability according to contemporary definitions, with no signal of excess valve failure for the SAPIEN 3 platform².

More recently, seven-year follow-up presented at TCT 2025 extended this observation, with sustained hemodynamic performance and similar durability outcomes between TAVR and SAVR. These data support the concept that, in appropriately selected low-risk patients, contemporary balloon-expandable TAVI can provide durable valve performance well beyond the early years after implantation.

For supra-annular self-expanding platforms, long-term experience from NOTION, which initially used early-generation technology, has now reached 10 years and remains highly influential. In that trial, long-term clinical outcomes and bioprosthetic valve outcomes were broadly comparable between TAVI and SAVR, reinforcing that transcatheter valves can remain functional for a decade in selected patients³.

However, more recent data from the Evolut Low Risk trial introduces an additional layer of nuance. Six-year results showed no significant difference in the primary composite clinical endpoint between TAVR and SAVR, although a higher rate of aortic valve reintervention was observed in the TAVR arm, particularly related to valvular regurgitation⁴. These findings highlight that durability encompasses not only structural valve integrity but also long-term valve competence and mechanisms of failure.

For intraannular self-expanding platforms, the evidence base is steadily growing and provides encouraging signals. Five-year data for the Portico system have demonstrated favourable clinical outcomes, stable hemodynamics, and low rates of structural valve deterioration⁵.

Insights from real-world data

Registry data provide an important complement to randomised trials. The EORP ESC Valve Durability TAVI Registry, published in 2025, evaluated long-term structural valve deterioration beyond five years after TAVI and reported a relatively low cumulative incidence of late structural deterioration⁶.

These findings are consistent with randomised data and reinforce the concept that true structural degeneration after TAVI remains relatively uncommon in the midterm, although interpretation is influenced by patient selection and competing risks.

Mechanisms of late valve dysfunction

Another important contemporary concept is that not all late transcatheter valve failure is structural. Non-structural dysfunction, patient–prosthesis mismatch, paravalvular regurgitation, leaflet thrombosis, and infective endocarditis may all affect long-term performance and may be clinically more relevant than classical leaflet degeneration in certain patients⁷.

This highlights the importance of comprehensive follow-up strategies, including echocardiography and, where appropriate, multimodality imaging. It also underscores the critical role of procedural quality at the index intervention. Implant depth, commissural alignment, coronary access preservation, annular sizing, and optimisation of residual regurgitation all directly influence long-term outcomes and future treatment options.

Durability in the context of lifetime management

From a European perspective, these considerations are increasingly reflected in guideline recommendations. The 2025 ESC/EACTS guidelines underline the importance of Heart Team–based decision-making and emphasise a lifetime management approach¹.

In practical terms, the durability discussion has evolved from a binary comparison of TAVI versus SAVR toward a more patient-centred question: which valve, in which anatomy, and in which sequence best preserves future therapeutic options.

Conclusion

The evidence base for TAVI durability is robust and continues to evolve. Contemporary data support excellent midterm durability across different valve platforms, with ongoing accumulation of long-term evidence.

Differences between devices appear to be less about whether durability is achieved and more about how valve performance evolves over time and how potential failure mechanisms can be anticipated and managed. The next phase of the field will therefore focus on optimising patient selection, device choice, and procedural strategy within a comprehensive lifetime management framework.

Key take-home messages

• TAVI demonstrates excellent midterm durability with low rates of structural valve deterioration up to 5–10 years
• Long-term data from randomised trials and registries are increasingly reassuring
• Differences between valve platforms relate more to mechanisms of failure than to overall durability
• Regurgitation and non-structural dysfunction are key drivers of late valve failure
• Procedural quality and implantation strategy are critical determinants of long-term outcomes
• Lifetime management has become central to device selection and treatment planning

References

1. Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2025;46(44):4635-736.
2. Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P, et al. Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years. N Engl J Med. 2023;389(21):1949-60.
3. Thyregod HGH, Jørgensen TH, Ihlemann N, Steinbrüchel DA, Nissen H, Kjeldsen BJ, et al. Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial. Eur Heart J. 2024;45(13):1116-24.
4. Forrest JK, Yakubov SJ, Deeb GM, Reardon MJ. Six-Year Outcomes After Transcatheter vs Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol. 2026.
5. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. New England Journal of Medicine. 2020;382(9):799-809.
6. Giannini C, Capodanno D, Toth GG, Windecker S, Schüpke S, Blackman DJ, et al. Long-term structural valve deterioration after TAVI: insights from the EORP ESC Valve Durability TAVI Registry. EuroIntervention. 2025;21(10):537-49.
7. Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, et al. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol. 2021;77(21):2717-46.

The Essentials - TAVI