Long-term durability of transcatheter aortic valve prostheses
Selected in the Journal of the American College of Cardiology by E. Asher , S. Brugaletta
This joint review is part of the PCRonline GLOBAL Journal Club Initiative by selected members of the EAPCI/PCR Journal Club and PCR NextGen, and is based on the underlying idea of “Bringing peers together, exchanging ideas, towards a common standard of care”.
References
Authors
Blackman DJ, Saraf S, MacCarthy PA, Myat A, Anderson SG, Malkin CJ, Cunnington MS, Somers K, Brennan P, Manoharan G, Parker J, Aldalati O, Brecker SJ, Dowling C, Hoole SP, Dorman S, Mullen M, Kennon S, Jerrum M, Chandrala P, Roberts DH, Tay J, Doshi SN, Ludman PF, Fairbairn TA, Crowe J, Levy RD, Banning AP, Ruparelia N, Spence MS, Hildick-Smith D
Reference
J Am Coll Cardiol. 2019 Feb 12;73(5):537-545
Published
February 2019
Link
Read the abstractReviewers
Our Comment
Why this study – the rationale/objective?
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis. However, there are very few data regarding long-term valve durability. The purpose of this study was to evaluate long-term valve function and to determine the incidence of hemodynamic structural valve degeneration (SVD) between 5 and 10 years after TAVR.
How was it executed – the methodology?
Demographic, procedural, and in-hospital outcome data on patients who underwent TAVR from 2007 to 2011 were obtained from the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) registry. Patients in whom echocardiographic data were available both at baseline and at 5 years post-TAVR were included. Hemodynamic structural valve deterioration (SVD) was determined according to European task force committee guidelines.
What is the main result?
- A total of 241 patients (79.3 ±7.5 years of age; 46% female) with paired post-procedure and late echocardiographic follow-up (median 5.8 years, range 5 to 10 years) were included. A total of 149 patients (64%) were treated with a self-expandable valve and 80 (34.7%) with a balloon-expandable valve.
- Peak aortic valve gradient at follow-up was lower than post-procedure (17.1 vs. 19.1 mm Hg; p = 0.002). More patients had none/trivial aortic regurgitation (AR) (47.5% vs. 33%), and fewer had mild AR (42.5% vs. 57%) at follow-up (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 to 8.6 years). Twelve of these (57%) were due to new aortic regurgitation and 9 (43%) to restenosis.
Critical reading and the relevance for clinical practice
The principal findings of this study are that the overall long-term function of transcatheter aortic heart valves was excellent, with an incidence of severe SVD of <0.5% and of moderate SVD of 8.7% at a median follow-up of 5.8 years.
There is now a significant body of randomised and registry data indicating good overall function of transcatheter aortic valves up to 5 years, with a very low incidence of SVD. Unfortunately, there are very few data on TAVR valve function beyond 5 years.
Although in this study there are data available in 168 patients at 6 years, 68 at 7 years, and 30 at 8 years, this is too small to reassure about long-term duration of TAVR valves and can be only considered as hypothesis-generating.
This can be considered a first step to understand about long-term value of TAVR and to see to which extent it can be applied to intermediate and low-risk profile patients.
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