TAVI Beyond 3 Years: Durability and Predictors for Survival

Area of Science:

• Cardiovascular Medicine
• Biomaterials Science

Background:

• Transcatheter aortic valve implantation (TAVI) has surpassed surgical aortic valve replacement in frequency over the last two decades.
• Limited data exist on the long-term durability and survival predictors following TAVI procedures.
• Factors influencing surgical bioprosthetic valve deterioration, such as calcification and mechanical stress, are likely relevant to TAVI.

Purpose of the Study:

• To review the current knowledge on transcatheter aortic valve implantation (TAVI) durability and survival.
• To identify key differences between TAVI and surgical valve replacement impacting long-term outcomes.
• To highlight areas requiring further investigation in TAVI research.

Main Methods:

• Review of existing literature on transcatheter aortic valve implantation (TAVI).
• Analysis of factors affecting bioprosthetic valve structural deterioration.
• Comparison of TAVI with surgical valve replacement outcomes, including mortality and complications.

Main Results:

• TAVI procedures are increasingly prevalent, particularly in older, comorbid patients.
• Long-term follow-up reveals significant mortality rates (50% at 5 years, 75% at 7 years).
• TAVI is associated with higher rates of conduction abnormalities and paravalvular leak compared to surgical replacement.

Conclusions:

• Understanding TAVI durability requires considering unique aspects like valve preparation and native anatomy interaction.
• High patient mortality in TAVI studies is often due to age and comorbidities.
• Further research is crucial to address knowledge gaps in TAVI long-term efficacy and patient survival.