Long-term follow-up after transcatheter aortic valve replacement

STRUCTURED ABSTRACT Background Transcatheter aortic valve replacement (TAVR) has become the standard of care in the majority of patients with symptomatic severe aortic stenosis. Data on long-term mortality and durability of transcatheter heart valves (THVs) beyond five years are limited. Our study aimed to assess elderly and high-risk patients’ long-term outcomes treated with TAVR in a prospective single-center registry focusing on the durability of THVs. Methods We included 795 patients with severe calcific aortic stenosis treated by transfemoral TAVR between 2006 and 2011. Echocardiography was performed at baseline, discharge, one year, and afterward annually until the longest available follow-up. Mortality rates were estimated for 1, 5, 6, 7, and 8 years. The rates of structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) were assessed in accordance with consensus definitions. Outcome measures were adjudicated according to VARC-2. Results Median [IQR] follow-up time was 1345 [316;2015] days. One-year, 5-year, 6-year, 7-year, and 8-year overall mortality was 25.4%, 59.0%, 64.6%, 67.9%, and 69.2%, respectively. At 8 years, no significant differences in mortality were found comparing self-expanding vs. balloon-expandable valves (69.5% vs. 68.0%, p=0.709) and postdilatation (PD) vs. no PD (69.4% vs. 69.2%, p=0.363). SVD was detected in 26 patients (3.3%), and 19 (2.4%) of the 795 patients had evidence of BVF during follow-up. Conclusions Our study demonstrates good long-term results for high-risk patients that were alive up to 8 years after TAVR.