Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in patients with severe aortic stenosis. However, data on long-term durability of bioprosthetic valve dysfunction (BVD) remain not enough. Therefore, we investigated the durability of transcatheter heart valve (THV) using new standardized criteria in patients at 5-year after TAVI. Hypothesis and Methods: From January 2012 to September 2015, among 114 patients with severe aortic stenosis, 28 and 86 patients underwent TAVI with self-expandable Medtronic CoreValve and balloon-expandable Edwards SAPIEN-XT, respectively.BVD was defined as Valve Academic Research Consortium 3 (VARC-3) criteria. Moderate/ severe hemodynamic valve deterioration (HVD) was defined as increase in mean transvalvular gradient > 10 mmHg/ > 20 mmHg resulting in mean gradient > 20 mmHg/ > 30 mmHg with concomitant decrease in effective orifice area (EOA) < 0.3 cm 2 / < 0.6 cm 2 or new occurrence or increase of > 1 grade/ > 2 grade of intra-prosthetic aortic regurgitation (AR) resulting in moderate/ severe AR. Bioprosthetic valve failure (BVF) was defined as valve related death, aortic valve reintervention, any bioprosthetic valve dysfunction associated with clinically expressive criteria or severe hemodynamic HVD. Results: During 5-year follow-up period, all-cause mortality was 43.8% (50 patients). There was 1 patient with severe BVD due to severe aortic regurgitation after CoreValve implantation. Four patients (3.5%) showed moderate BVD, which resulted in increased mean THV gradient, and all of whom received SAPIEN-XT implantation. BVF occurred in 2 patients (1.8%) during 5 years after CoreValve and SAPIEN-XT implantation. Follow-up echocardiography at 5 year were conducted in 48 patients (42.1%). The mean pressure gradient was 7.7 ± 3.8 mmHg and 11.9 ± 4.9 mmHg in patients with CoreValve and SAPIEN-XT, respectively (p=0.012). Conclusions: This study was evaluated THV durability using the VARC-3 definition. The incidence of BVD were uncommon during long-term follow-up period. Furthermore, the 5-years’ THV performance of early generation balloon-expandable and self-expandable device were maintained after TAVI.

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