Valve Deterioration after TAVI Is Rare and Should Not Prevent Advancement to Younger Populations

Durability ─or better yet, lack of deterioration─ is still a matter of debate when considering transcatheter aortic valve intervention (TAVI), especially now that it is being explored as a real alternative for younger patients.

A recently published meta-analysis offers more evidence and suggests TAVI deterioration is mostly rare within the first 5 years.

According to this work, the estimated incidence of valve dysfunction would be roughly 28 every 10000 patients/year. This figure appears to be reassuring, but we should bear in mind the experience of surgical biological valves, which increasingly deteriorate after 10 years (and even more after 15). We might need more long term data to recommend TAVI for younger patients. 

This is the first systematic large revision on this topic. However, it has a problem: on one side, patients with longer follow up have first generation devices (there was no anti calcification treatment) and on the other hand, it was hard to follow up patients at long term, since the first patients were either too old, high risk or inoperable.

This revision included data from 13 observational studies, with a total 8914 patients and a mean follow up between 1.6 and 5 years.

Also Read: “Dual Antiplatelet in TAVI, Is Single Better?”.

With a mean incidence of 28.08 cases per 10000 patients/year, the range between the included studies goes from as low as 0 incidence to as high as 134 per 10000 patients/year. 

Five studies reported a cause for dysfunction, which more often was restenosis, with 58%, followed by insufficiency with 39%, and a combination of both with 3%.

Only 3 patients received another valve to treat the first valve dysfunction, while the rest only received medical treatment, because patients were elderly, fragile or simply died before the second intervention.

Also Read: “How to classify aortic stenosis of TAVI patients”.

Quite unexpectedly, and after adjusting all possible confounders, we observed self-expandable valves showed 6.4 more dysfunction every 10000 patients/year than those receiving the self-expandable valve (p=0.036).

The self-expandable valve was expected to deteriorate earlier because of its mechanical impact on the valve.

However, data are inconsistent across studies, which invalids all speculation as regards different deterioration rates between expandable and self-expandable valves.

The use of anticoagulation at discharge seemed to benefit valve life, but this association disappeared when adjusting for other confounding factors.

Original title: Structural Valve Deterioration after Transcatheter Aortic Valve Implantation.

Reference: Heart. 2017 Jul 6. [Epub ahead of print].

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