Assessment of long-term durability of transcatheter aortic valves, a French multicenter retrospective study

Abstract

Recommendations have upgraded transcatheter aortic valve implantation (TAVI) indications. It is currently an alternative to conventional surgery in intermediate risk patients. As the indications extended to patients with potentially longer life expectancy, the topic of durability of percutaneous aortic bioprostheses becomes crucial. We evaluated the durability of these bioprostheses through this French multicentric study offering the longest follow-up in Europe. All patients treated with TAVI in 5 French centers from 2002 to 2011 were included. Bioprosthetic valve failure (BVF) was defined as repeated intervention or severe structural valve deterioration (SVD). Patients selected for the durability analysis were those who had an echocardiography at least one year before the last follow-up. SVD was evaluated according to the recent definition: moderate when mean transprosthetic gradient was > 20 mmHg and < 40 mmHg with an increase of > 10 and < 20 mmHg and/or with a moderate intra-prosthetic aortic regurgitation (AR), new or worsening from baseline; severe when mean gradient was > 40 mmHg with an increase of > 20 mmHg and/or with a severe intra-prosthetic AR. During this period 1403 patients were included. Mean duration follow-up was 3.6 ± 2.1 years, maximum duration was 10.2 years. Survival rates were 39.1% (95% CI: 36.3–41.8) and 13.4% (95% CI: 9.7–17.0) at respectively 5 and 8 years. In total, 589 patients were eligible for the durability analysis (46.6%). BVF occurred in 18 patients (1.4%). Among them, 5 patients required re-intervention. Risk of BVF at 10 years was 3.4% (95% CI: 1.7–5.9). Moderate SVD occurred in 41 patients (7.0%), risk of moderate SVD was 17.0% (95% CI: 9.1–26.0) at 10 years. Severe SVD occurred in 15 patients (2.5%), risk of severe SVD was 8.0% (95% CI: 3.3–15.2) at 10 years. Our study does not highlight any alarm signal concerning percutaneous aortic bioprostheses durability.