Seven-Year Clinical and Durability Outcomes of Balloon-Expandable Transcatheter Aortic Valve Implantation in a...

Long-term durability data for early-generation balloon-expandable transcatheter aortic valve implantation (TAVI) in Turkish populations remain limited. The authors evaluated 7-year clinical outcomes and valve durability according to the Valve Academic Research Consortium (VARC-3) criteria.

In this single-center registry, 270 consecutive patients with symptomatic severe aortic stenosis treated with the early-generation balloon-expandable SAPIEN XT valve (January 2012-March 2017) were included. Clinical and echocardiographic outcomes were assessed up to 7 years. The primary endpoint was all-cause mortality. Structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) were defined according to the VARC-3 criteria. Cumulative incidence was estimated using competing-risk analysis, with death from any cause treated as a competing event. Predictors of mortality were evaluated using Cox regression.

At 7 years, cumulative survival was 29.6%. Cardiovascular and non-cardiovascular mortality occurred at comparable rates. In multivariable analysis, higher Katz index, reflecting better functional status, and higher body mass index were inversely associated with all-cause mortality, whereas eGFR <30 mL/min/1.73 m² was associated with increased mortality risk. The 5- and 7-year cumulative incidences of combined Stage 2-3 SVD were 0.74% and 3.72%, respectively; BVF rates were 1.11% and 2.23%, respectively.

In this Turkish single-center cohort treated during the early TAVI era, long-term outcomes reflected the advanced age and comorbidity burden of the study population. Using a competing-risk framework, the observed cumulative incidence of SVD and BVF was low at 5 and 7 years; however, these findings should be interpreted in the context of substantial competing mortality.