Incidence and Impact of Structural Valve Deterioration Following TAVI: a Multicenter Real-World Study.

Objective: Valve durability becomes a major issue as transcatheter aortic valve implantation (TAVI) is expanding to populations with longer life expectancy. We sought to i) determine the incidence of structural valve deterioration (SVD), ii) compare the incidence of SVD between balloon-expandable (BE) and self-expandable (SE) valves, and iii) analyze the impact of SVD.

Results: 2040 patients who underwent TAVI (2007-2020) from 9 centers were included. After inverse probability treatment weighting (IPTW), 1848 patients were selected (973 BE and 875 SE). SVD was defined using recent echocardiographic definitions according to VARC-3 criteria: Median follow-up was 4.2 (IQR: 2.5-5.7) years. The estimated incidence of SVD and bioprosthetic valve failure (BVF) at 8-years follow-up for the overall cohort were 13.3% (95%CI 9.8-18%) and 11.5% (95%CI 8.9-14.8%), respectively. After IPTW and a median follow-up of 4 years, the risk of SVD (5.25 % vs. 1.19%; HR 10.25, 95%CI 3.79-27.71, p <0.001), and all-cause BVF (6.41% vs. 3.2%; HR 2.1, 95%CI 1.27-3.47 p=0.004), was significantly higher for BE compared to SE recipients. Patients developing SVD had a trend towards a higher incidence of cardiovascular death (p=0.06), as well as a significantly higher risk of heart failure rehospitalization (p=0.048). After IPTW, there were no differences between BE and SE recipients in the combined endpoint of cardiovascular death, heart failure rehospitalization and valve reintervention (p=0.46).

Conclusions: In this real-world registry, the incidence of SVD at 8-years after TAVI was relatively low. The risk of SVD was higher among BE compared to SE valve recipients. SVD was associated with increased risk of heart failure rehospitalization and a trend towards a higher risk of cardiovascular death.