Acta cardiologica · 2025
Hemodynamic performance and durability of transcatheter valves for the treatment of native aortic valve stenosis.
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Meylaers Michiel, Minten Lennert, Van Langenhoven Leen, Lesizza Pierluigi, Van Lint Victor, Noé Dries, van Der Hauwaert Roxanne, Petrus van Otzel Reinier, Jacobs Steven, Verbrugghe Peter, Rex Steffen, Nuyens Philippe, Meuris Bart, Herregods Marie-Christine, Adriaenssens Tom, Dubois Christophe
Аннотация
BACKGROUND/INTRODUCTION: Long-term data on hemodynamic performance and valve durability are essential to guide bioprosthetic valve selection and to safely expand transcatheter aortic valve implantation (TAVI) to lower-risk patients with severe aortic stenosis (AS).
PURPOSE: This study aimed to assess the hemodynamic valve performance in a large cohort of patients undergoing TAVI with balloon-expandable (BEV) or self-expandable valves (SEV) and identify possible predictors of bioprosthetic valve degeneration (BVD).
METHODS: All patients undergoing TAVI for native AS in a single centre between March 2008 and September 2023 underwent sequential echocardiographic follow-up at 30 days, 6 months and yearly thereafter. BVD was categorised as moderate or severe according to the Valve Academic Research Consortium 3 criteria.
RESULTS: 784 patients (82 ± 7 years, 53.1% male, median EuroSCORE II 6.0% (3.6;10.7)) were treated with BEV (n = 584; 74.5%) or SEV (n = 200; 25.5%). Patients treated with BEV had a significantly higher 30-day mean transprosthetic gradient (TPG) (10.8 (95% CI 10.4-11.2) vs 6.8 mmHg (95% CI 6.3-7.4), p < 0.0001), but fewer more-than-mild aortic regurgitation as compared with SEV. Moderate/severe BVD were observed in 29 and 8 patients respectively, corresponding with a 6-year cumulative incidence of 7.3% (95% CI 5.0-10.1%). BVD was significantly associated with all-cause mortality for moderate (HR 2.2, 95% CI 1.3-4.0, p = 0.0051) and severe BVD (HR 4.5, 95% CI 1.4-14.1, p = 0.0105). Both a mean post-implantation TPG > 9 mmHg (HR 2.2; 95% CI 1.0-5.0, p = 0.0456) and implantation of the 20 mm SAPIEN BEV (n = 4) (HR 6.8; 95% CI 1.5-30.3, p = 0.0114) were associated with an increased incidence of BVD.
CONCLUSION: BVD is a rare complication in elderly intermediate-to-high risk patients undergoing TAVI. However, BVD is associated with increased mortality.
PURPOSE: This study aimed to assess the hemodynamic valve performance in a large cohort of patients undergoing TAVI with balloon-expandable (BEV) or self-expandable valves (SEV) and identify possible predictors of bioprosthetic valve degeneration (BVD).
METHODS: All patients undergoing TAVI for native AS in a single centre between March 2008 and September 2023 underwent sequential echocardiographic follow-up at 30 days, 6 months and yearly thereafter. BVD was categorised as moderate or severe according to the Valve Academic Research Consortium 3 criteria.
RESULTS: 784 patients (82 ± 7 years, 53.1% male, median EuroSCORE II 6.0% (3.6;10.7)) were treated with BEV (n = 584; 74.5%) or SEV (n = 200; 25.5%). Patients treated with BEV had a significantly higher 30-day mean transprosthetic gradient (TPG) (10.8 (95% CI 10.4-11.2) vs 6.8 mmHg (95% CI 6.3-7.4), p < 0.0001), but fewer more-than-mild aortic regurgitation as compared with SEV. Moderate/severe BVD were observed in 29 and 8 patients respectively, corresponding with a 6-year cumulative incidence of 7.3% (95% CI 5.0-10.1%). BVD was significantly associated with all-cause mortality for moderate (HR 2.2, 95% CI 1.3-4.0, p = 0.0051) and severe BVD (HR 4.5, 95% CI 1.4-14.1, p = 0.0105). Both a mean post-implantation TPG > 9 mmHg (HR 2.2; 95% CI 1.0-5.0, p = 0.0456) and implantation of the 20 mm SAPIEN BEV (n = 4) (HR 6.8; 95% CI 1.5-30.3, p = 0.0114) were associated with an increased incidence of BVD.
CONCLUSION: BVD is a rare complication in elderly intermediate-to-high risk patients undergoing TAVI. However, BVD is associated with increased mortality.