Outcomes beyond 10 years of transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis

Ines Richter (Leipzig)1, E. Dietze (Leipzig)1, O. Dumpies (Leipzig)1, J. Rotta Detto Loria (Leipzig)1, N. Majunke (Leipzig)1, H.-J. Feistritzer (Leipzig)1, P. Kiefer (Leipzig)2, T. Noack (Leipzig)2, S. Desch (Leipzig)1, M. A. Borger (Leipzig)2, H. Thiele (Leipzig)1, M. Abdel-Wahab (Leipzig)1

1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 2Herzzentrum Leipzig - Universität Leipzig Universitätsklinik für Herzchirurgie Leipzig, Deutschland


Limited data is available on long-term outcomes and valve durability measures of transcatheter aortic valve implantation (TAVI) beyond 5 years. This study sought to assess clinical and echocardiographic outcomes of high-risk patients treated during the early experience of TAVI at a single high-volume European center with a follow-up period extending beyond 10 years. 

We included a total of 1825 patients who had undergone TAVI at the Heart Center Leipzig between 2006 and 2012. Valve durability measures including structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) were defined according to the updated standardized definitions of the Valve Academic Research Consortium 3 (VARC-3). 

The 1-, 3-, 5-, 7-,10, and 12-year mortality rates were 25.7%, 41.3%, 58.0%, 71.8%, 87.6% and 92.8%. At 12 years post-TAVI, the cumulative incidence of any SVD was 9.76% in the total population, with a numerically higher rate of SVD in balloon-expandable (BE) transcatheter heart valves (THVs) compared with self-expanding (SE) THVs (14.7% vs 4.1%, p=0.110). Complete echocardiographic follow-up at ≥ 9 years was available for 56 patients. The median follow-up duration of this subgroup was 10.0 years, with the longest follow-up period reaching 12.8 years. At long-term follow-up, patients had a mean transvalvular pressure gradient of 7.8 [5.0; 12.0] mmHg and an EOA of 1.5 [1.4; 2.0] cm². Moderate SVD was observed in three patients of the echocardiographic follow-up cohort (5.4%) and severe SVD in two patients (3.6%). SE THVs had a significantly lower rate of any SVD than BE THVs (3.1% vs 20.0%, p=0.045). There was no significant difference in mortality between both THV types (p=0.391). Patients with ≥ mild post-procedural aortic regurgitation (AR) had a significantly higher mortality than patients without postprocedural AR (p=0.007). 

Long-term mortality rates in high-risk patients treated with TAVI more than 10 years ago remain high, which limits assessment of valve durability measures in this patient population. Even mild postprocedural AR might impact long-term survival after TAVI. In a subgroup of survivors beyond 9 years, the cumulative incidence of SVD was low and SE valves showed superior durability compared with BE valves, with no effect on mortality. 

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