Abstract
Background Transcatheter aortic valve replacement (TAVR), widely used as an alternative therapy in patients with severe aortic stenosis, is expected to be offered to low-risk patents with a longer life expectancy. The durability of transcatheter aortic valve is becoming of increasing importance. Method PubMed, Embase, and Cochrane CENTRAL from the inception to March 2020 were systematically screened for studies reporting on structural valve deterioration (SVD) in TAVR patients. Incidence of SVD was diagnosed according to the latest European consensus as the primary end point. Predictors of SVD evaluated at multivariable analysis and cumulative incidence function (CIF) of SVD were the secondary end point. Result Twelve studies encompassing 10031 patients evaluating the incidence of SVD were included, with a follow-up between 1 and 8 years. The pooled incidence of SVD was 4.93% (95% CI, 2.75%–7.70%, I2 = 96%) at 1 year and 8.97% (95% CI, 6.89%–11.29%, I2 = 86%) in the long term (≥5 years). Subgroup analysis was performed to identify the valve type that may result in partial heterogeneity. SVD was more frequent in patents with a valve diameter of <26 mm (HR: 3.57, 1.47–8.69), oral anticoagulants (OAC), exposure at discharge (OR: 0.48, 0.38–0.61), or by a disease of renal dysfunction (OR 1.42, 1.03–1.96). Conclusion SVD represents infrequent events after TAVR in the long term (>5 years), occurring more commonly in renal dysfunction patients, with small valve diameter and without OAC exposure. There may be an underestimation of the incidence if we assume death as a competing risk.
Highlights
Transcatheter aortic valve replacement (TAVR), widely accepted as one of the major advances in therapy of severe aortic stenosis, was limited to high-risk or inoperable patients originally [1]
There were studies focusing on TAVR in low-risk population, and they presented noninferior [5] or even superior [6] outcomes compared with surgical aortic valve replacement (SAVR). e anticipation of target patients in TAVR with a longer life expectancy has already raised concerns about the durability of transcatheter aortic valves (TAVs)
Two-hundred and fourteen studies were identified by the electronic database searches after removing duplicate articles, of which 202 did not meet the inclusion criteria for reasons such as not reporting the incidence of structural valve deterioration (SVD) or not following the guideline of European Association of Percutaneous Cardiovascular Interventions (EAPCI)
Summary
Transcatheter aortic valve replacement (TAVR), widely accepted as one of the major advances in therapy of severe aortic stenosis, was limited to high-risk or inoperable patients originally [1]. In consideration of the limited, long-term followup data and the lack of a consensus definition of SVD across studies, the pooled incidence of SVD was likely underestimated and doubted. Transcatheter aortic valve replacement (TAVR), widely used as an alternative therapy in patients with severe aortic stenosis, is expected to be offered to low-risk patents with a longer life expectancy. SVD represents infrequent events after TAVR in the long term (>5 years), occurring more commonly in renal dysfunction patients, with small valve diameter and without OAC exposure. SVD represents infrequent events after TAVR in the long term (>5 years), occurring more commonly in renal dysfunction patients, with small valve diameter and without OAC exposure. ere may be an underestimation of the incidence if we assume death as a competing risk
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