Transcatheter Heart Valve Durability Research Articles

Long-term assessment of durability of transcatheter aortic valves. Experience from the pioneer center

In the context of extension of transcatheter aortic valve implantation (TAVI) indications, transcatheter heart valve durability is a pivotal concern. Being the pioneer center since Fist-In-Man TAVI provides us the longest worldwide follow-up. We aimed to report long-term outcomes and assess valve durability by evaluating structural valve deterioration (SVD) in patients treated with balloon-expandable TAVI prior to 2011. From 2002 to 2011, 242 patients underwent balloon-expandable TAVI in our center. On site clinical and echocardiographic follow-up were scheduled at one month, one year and yearly thereafter. In the absence of universal definition of SVD, we used the surgical definition, survival without reintervention, and proposed a definition using echocardiographic criteria. SVD was considered moderate when mean aortic gradient was ≥ 20 mmHg and < 40 mmHg and/or aortic central regurgitation was moderate, and severe when mean aortic gradient was ≥ 40 mmg and/or aortic central regurgitation was severe. SVD was defined as definite, probable, or possible. Mean age was 82.2 years. Patients were highly symptomatic (79.1% in NYHA III/IV), mean logistic Euroscore was 25.5 ± 14.2%. 30-day mortality was 12.1%. Survival rate was 68.3 ± 3.0%, 26.9 ± 2.9%, and 5.3 ± 2.0% at one-, 5- and 10-years, respectively. Using surgical definition, only one patient required reintervention for symptomatic SVD and freedom from SVD at 10y was 93.8 ± 6.1%. According to our definition, 1 patient had probable severe SVD, 2 had probable moderate SVD, 1 had possible moderate SVD and freedom from SVD at 10 y was 87.7 ± 6.6% ( Fig. 1 ). Our data do not demonstrate an alarm on durability. Long-term assessment of transcatheter aortic valve is difficult given the high mortality of the studies population. Further studies are required to estimate accurately TAVI durability. When assessing SVD and comparing TAVI to surgery, SVD definition should be universal.

Transcatheter aortic valve replacement

The standard treatment for symptomatic severe aortic valve stenosis is surgical aortic valve replacement. Over the last decade, transcatheter aortic valve replacement has emerged as an option for patients judged inoperable. It might also constitute an alternative for high-risk patients, even though which patients might benefit from this approach is still being discussed and remains controversial. Transcatheter heart valve replacement is a rapidly spreading technology. However, a number of problems still need to be addressed, such as paravalvular regurgitation, stroke rate, and postoperative conduction disturbances. Further, the durability of transcatheter heart valves remains unclear. Randomized clinical trials and long-term follow-up will help

Reversible Edwards Sapien XT Dysfunction Due to Prosthesis Thrombosis Presenting as Early Structural Deterioration

To the Editor: Transcatheter aortic valve implantation (TAVI) continues to penetrate into daily practice supported by increasing data demonstrating efficacy and safety on the short- to medium-term but the long-term durability of transcatheter heart valves (THV) remains unknown. In this report, we