Hemodynamic Valve Deterioration After Transcatheter Aortic Valve Replacement

BACKGROUND: Reports on the durability of transcatheter aortic valve replacement (TAVR) prostheses are scarce and confounded by varying definitions and competing risks of death. OBJECTIVES: The authors sought to determine the incidence, predictors, and clinical outcomes of hemodynamic valve deterioration (HVD) according to the Valve Academic Research Consortium 3 definition after TAVR. METHODS: We analyzed consecutive patients undergoing TAVR in the prospective Bern TAVI (Transcatheter Aortic Valve Implantation) registry between August 2007 and June 2022 for the incidence and predictors of HVD and performed case control-matching to compare outcomes according to HVD. RESULTS: A total of 2,403 eligible patients (mean age 81.8 ± 6.2 years, median Society of Thoracic Surgeons Predicted Risk of Mortality score 3.8% [Q1-Q3: 2.4%-6.0%]) were included and had a median duration of follow-up of 376 days (Q1-Q3: 365-1,825 days). The cumulative incidence of moderate or severe HVD was 2.2% (95% CI: 1.6%-3.1%), 10.8% (95% CI: 9.2%-12.7%), and 25.6% (95% CI: 17.5%-36.5%) at 1, 5, and 10 years, respectively. Aortic valve complex calcium volume (HR: 1.81; 95% CI: 1.11-2.97; P = 0.018), residual aortic regurgitation at discharge (HR: 1.87; 95% CI: 1.34-2.60; P < 0.001), and treatment with oral anticoagulants (HR: 1.78; 95% CI: 1.00-3.15; P = 0.048) were independent predictors of HVD. In the case control-matched cohort (HVD, n = 155, no-HVD, n = 600), patients with HVD had similar yearly rates of all-cause and cardiovascular mortality, and infective endocarditis, but higher rates of repeat aortic valve intervention (rate ratio [RR]: 4.81 [95% CI: 1.74-13.26]; P = 0.001). CONCLUSIONS: HVD occurred in up to 1 in 4 patients throughout 10-year post-TAVR and was associated with a 5-fold increase in the risk of aortic valve reintervention.