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Durability of prostheses for transcatheter aortic valve implantation

Key Points

  • Reliable long-term data for transcatheter aortic valve implantation (TAVI) devices are currently available only for up to 5 years

  • Experience with surgical aortic valves indicates that ≥10-year follow-up is required in elderly patients to analyse valve durability

  • An inverse association exists between age and structural valve deterioration, which therefore is unlikely to occur rapidly in the typical octogenarian population of TAVI recipients

  • Valve-in-valve TAVI is the first-line therapy for failed surgical and transcatheter aortic valves, and can extend the lifespan of bioprostheses

Abstract

Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients, and the preferred treatment option for high-risk patients with severe aortic stenosis. Given that this therapy was intended for elderly patients with limited life expectancy, long-term durability has not been in the focus. Now that TAVI is increasingly being used in patients with intermediate-risk and lower-risk profiles, device durability has gained importance. The available mid-term results for TAVI are promising; however, little is known about the fate of TAVI devices beyond 5 years. The experience with long-term durability of surgical valves shows that ≥10-year follow-up is required to ensure reliable durability data. In this Review, we discuss the existing studies of TAVI durability, highlight differences between surgical and transcatheter treatment of aortic stenosis that might influence durability, and present a clinical solution for failed prostheses. Furthermore, we suggest how device durability might influence the future selection of patients for TAVI.

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Figure 1: Types of surgical and transcatheter aortic valves.
Figure 2: Pathological specimens showing the most common reasons for bioprosthetic valve failure.
Figure 3: Freedom from valve deterioration according to patient age after aortic valve replacement with a Mitroflow® valve (Sorin Group, Canada).
Figure 4: Valve-in-valve implantations in degenerated surgical valves.

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Acknowledgements

We thank John J. Squiers (Baylor Research Institute, Baylor Healthcare System, Dallas, Texas, USA) for his editorial support during preparation of this manuscript.

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Both authors researched data for the article, discussed its content, and wrote, reviewed, and edited the manuscript before submission.

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Correspondence to Thomas Walther.

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Arsalan, M., Walther, T. Durability of prostheses for transcatheter aortic valve implantation. Nat Rev Cardiol 13, 360–367 (2016). https://doi.org/10.1038/nrcardio.2016.43

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