Abstract
Background: Transcatheter aortic valve replacement (TAVR) is now an acceptable treatment for patients at high surgical risk. Recent limited data raise some concerns on valve durability long-term. We aim to determine structural valve deterioration (SVD) in TAVR over 5-year implant durations. Methods: Patients undergoing TAVR with Edwards SAPIEN/SAPIEN XT or Medtronic CoreValve prostheses at The Prince Charles Hospital between August 2008 and November 2011 with echocardiographic follow-up of a minimum of 5 years were included. Exclusion criteria included cases with aortic endocarditis, index valve-in-valve cases, and patients lost to follow-up. Valve performance was assessed using VARC-2 criteria for SVD and analysed using JMP 13 statistical software. Results: 28 patients (average age 82.14 ± 8.68 years) met selection criteria, who underwent TAVR with either Edwards (n = 12) or Medtronic (n = 16) valves. Average STS score was 6.43 ± 2.88 and average EuroSCORE was 18.74 ± 8.53. Comparison of 30-day (30D) post-implant data with 5 year (5Y) follow up data showed a slight increase in mean aortic gradient (30D: 10.46 ± 2.92 mmHg; 5Y:12.52 ± 15.26 mmHg; p = NS). Only one patient demonstrated a mean gradient increase of over 20 mmHg. This patient required a TAVR-in-TAVR 8 years post-initial TAVR. Aortic valve area showed a slight decrease (30D: 2.03 ± 0.37 cm2; 5Y: 1.83 ± 0.54 cm2; p = NS). 2 (7.1%) patients showed moderately severe/severe valvular or circumferential aortic regurgitation (grade ≥ 3) 5 years post-implant. Conclusion: In this small observational cohort, TAVR SVD requiring reintervention was infrequently observed. Defining SVD for TAVR and longer-term follow-up will be essential for the future.
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