The Canadian journal of cardiology · 2025
Early Bioprosthetic Valve Deterioration Within 5 Years Following Transcatheter Aortic Valve Replacement.
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Chedid Maroun, Adamek Andrew, Bergstedt Seth, Bapat Vinayat, Gössl Mario
Аннотация
BACKGROUND: Early bioprosthetic valve deterioration (BVD) after transcatheter aortic valve replacement (TAVR) remains a significant clinical concern, occurring in up to 10% of patients at 5 years post-TAVR. In this study we assessed the prevalence and risk factors for early BVD occurring within 5 years after TAVR, and its clinical implications in patients undergoing TAVR.
METHODS: We conducted a retrospective cohort study of 306 patients from among 1291 who underwent TAVR and either developed BVD within 5 years or had at least 3 years of follow-up without BVD. Early BVD was defined according to Valve Academic Research Consortium-3 criteria. The primary outcome was prevalence of early BVD. We also assessed the association between hypoattenuated leaflet thickening (HALT), anticoagulation status at TAVR, and early BVD. Kaplan-Meier curves evaluated the impact of early BVD on mortality, heart failure hospitalizations, and redo TAVR.
RESULTS: Among the 306 patients with TAVR, 44 (14.3%) developed early BVD. Baseline characteristics were similar between groups. HALT was associated with early BVD (30% vs 5%, P < 0.001). Patients on anticoagulation at TAVR had lower rates of early BVD (4.3% vs 20.6%, P < 0.001) and HALT (4.3% vs 11.1%, P = 0.06). Early BVD correlated with earlier mortality (1.56 vs 5.10 years, P = 0.022), heart failure hospitalizations (1.10 vs 4.22 years, P = 0.004), and increased redo TAVR (11% vs 0.8%, P = 0.001).
CONCLUSIONS: The prevalence of early BVD in our cohort was higher when compared with other studies. HALT was strongly associated with the occurrence of early BVD. Our findings suggest that anticoagulation may play a protective role in mitigating BVD.
METHODS: We conducted a retrospective cohort study of 306 patients from among 1291 who underwent TAVR and either developed BVD within 5 years or had at least 3 years of follow-up without BVD. Early BVD was defined according to Valve Academic Research Consortium-3 criteria. The primary outcome was prevalence of early BVD. We also assessed the association between hypoattenuated leaflet thickening (HALT), anticoagulation status at TAVR, and early BVD. Kaplan-Meier curves evaluated the impact of early BVD on mortality, heart failure hospitalizations, and redo TAVR.
RESULTS: Among the 306 patients with TAVR, 44 (14.3%) developed early BVD. Baseline characteristics were similar between groups. HALT was associated with early BVD (30% vs 5%, P < 0.001). Patients on anticoagulation at TAVR had lower rates of early BVD (4.3% vs 20.6%, P < 0.001) and HALT (4.3% vs 11.1%, P = 0.06). Early BVD correlated with earlier mortality (1.56 vs 5.10 years, P = 0.022), heart failure hospitalizations (1.10 vs 4.22 years, P = 0.004), and increased redo TAVR (11% vs 0.8%, P = 0.001).
CONCLUSIONS: The prevalence of early BVD in our cohort was higher when compared with other studies. HALT was strongly associated with the occurrence of early BVD. Our findings suggest that anticoagulation may play a protective role in mitigating BVD.