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

BACKGROUND: 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. AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.