Predictors of long-term structural valve deterioration and failure after transcatheter aortic valve implantation

Independent predictors and prognostic correlates of structural valve deterioration (SVD) after transcatheter aortic valve implantation (TAVI) have not been investigated beyond 5-year follow-up.

We aimed to investigate the association between the early residual mean postprocedural gradient (ERMPG) after TAVI and long-term SVD rates as well as the association of SVD with bioprosthetic valve failure (BVF) and 10-year mortality rates.

Patients with severe aortic valve stenosis enrolled in the Medtronic One Hospital Clinical Service at 10 Italian centres were included in the study. ERMPG was measured with echo-Doppler at hospital discharge or within 3 months from TAVI.

Between September 2007 and December 2014, 1,291 patients undergoing TAVI with a CoreValve/Evolut valve met the enrolment criteria of the study. After a median follow-up of 59.4 months, there were 46 patients with SVD (cumulative incidence rate 3.6%). A significant stepwise increase in the risk of SVD was apparent across tertiles of ERMPG (p=0.009), and in the multivariable analysis, ERMPG was an independent predictor of SVD (adjusted subdistribution hazard ratio [sHR] 1.05, 95% confidence interval [CI]: 1.01-1.08; p=0.004). Among the 46 patients with SVD, 25 (54.3%) had or developed BVF. SVD was associated with increased 10-year rates of all-cause mortality (adjusted hazard ratio 2.12, 95% CI: 1.49-3.00; p<0.001) and cardiac mortality (adjusted sHR 5.78, 95% CI: 2.63-12.71; p<0.001) compared with no SVD.

Echo-Doppler-derived ERMPG measured within 90 days from TAVI is an independent predictor of SVD. SVD is associated with high rates of BVF, and it is an independent predictor of all-cause mortality and cardiovascular mortality.