Ten year follow-up of high-risk patients treated during the early experience with transcatheter aortic valve replacement.

Abstract

BACKGROUND:

The long-term clinical performance of transcatheter heart valves (THV) is unknown.

AIMS:

This study assessed the clinical outcomes, rate of structural valve deterioration (SVD) and bioprosthetic valve failure in patients after transcatheter aortic valve replacement (TAVR) to 10-year follow-up.

METHODS:

Consecutive patients undergoing TAVI for native aortic valve stenosis or failed aortic surgical bioprosthesis, between 2005 and 2009 at our institution were included. A total of 235 consecutive patients.

RESULTS:

At the time of TAVI mean age was 82.4 ± 7.9 years. All patients were judged to be high risk, with a STS score > 8 in 53.6%. THVs implanted were the Cribier-Edwards (20.9%), Edwards SAPIEN (77.4%) or CoreValve (1.7%). Mortality at 1, 5, and 10-year follow-up was 23.4%, 63%, and 91.6%, respectively. Of the total cohort, 15 patients had structural valve deterioration/bioprosthetic valve failure, with a cumulative incidence at 10-years of 6.5% (95% CI 3.3%, 9.6%). The rate of SVD/BVF at 4, 6, 8, and 10 years was 0.4%, 1.7%, 4.7%, and 6.5%, respectively. Nine patients had moderate SVD and six patients had severe SVD. Of the six patients with severe SVD, two patients had reintervention (one patient had redo TAVR, and the second had surgical aortic valve replacement). Survivors (n = 19) at 10-year follow-up, had a mean gradient of 14.0 ± 7.6 mmHg and aortic regurgitation ≥moderate in 5%. Quality of life measures in 10-year survivors demonstrated ADLs 6/6 in 43.8%, and ambulation without a mobility aid of 62.5%.

CONCLUSION:

Using early generation balloon expandable THVs in a high-risk population, there was a low rate of structural valve deterioration and valve failure at 10-year follow-up. This study provides insights into the long-term performance of transcatheter heart valves and patients self-reported derived benefits.

• Authors: Janarthanan Sathananthan, Sandra Lauck, Jopie Polderman, Maggie Yu, Anna Stephenson, Gnalini Sathananthan, Robert Moss, Anson Cheung, Jian Ye, Philipp Blanke, Jonathon Leipsic, David A Wood, John G Webb
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 97 Issue 3 Pg. E431-E437 (02 15 2021) ISSN: 1522-726X [Electronic] United States
• PMID: 32940418 (Publication Type: Journal Article)
• Copyright: © 2020 Wiley Periodicals LLC.

Topics

• Aged, 80 and over
• Aortic Valve (diagnostic imaging, surgery)
• Aortic Valve Stenosis (diagnostic imaging, surgery)
• Bioprosthesis
• Follow-Up Studies
• Heart Valve Prosthesis
• Humans
• Prosthesis Design
• Prosthesis Failure
• Quality of Life
• Transcatheter Aortic Valve Replacement (adverse effects)
• Treatment Outcome