Long-Term Functional and Structural Durability of Bioprosthetic Valves Placed in the Aortic Valve Position via Percutaneous Rout in Israel

• Published in: The American journal of cardiology 2019-12, Vol.124 (11), p.1748-1756
• Main Authors: Orvin, Katia, Zekry, Sagit Ben, Morelli, Olga, Barabash, Israel M., Segev, Amit, Danenberg, Haim, Assali, Abid, Guetta, Victor, Assa, Hana Vaknin, Zeniou, Vicki, Lotan, Chaim, Sagie, Alexander, Gilon, Dan, Feinberg, Micha S., Shapira, Yaron, Kornowski, Ran
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aortic stenosis; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Balloon treatment; Bioprosthesis; Cardiology; Cardiovascular disease; Data acquisition; Durability; Echocardiography; Female; Follow-Up Studies; Heart Valve Prosthesis; Heart valves; Hemodynamics; Hemodynamics - physiology; Hospitals; Humans; Implantation; Israel; Male; Medical instruments; Mercury; Mortality; Prostheses; Prosthesis Design; Prosthetic valves; Prosthetics; Registries; Stenosis; Structure-function relationships; Surgical implants; Time Factors; Transcatheter Aortic Valve Replacement - methods; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.08.043

There is limited organized “real life” data regarding the long-term structural and functional durability of transcatheter aortic valve implants, a topic of major importance. We assessed the 5-year structural and functional integrity outcomes following trans-catheter aortic valve implantation (TAVI) with both self-expandable and balloon-expandable prosthetic valve devices. This study included 450 consecutive patients who underwent TAVI for severe symptomatic aortic stenosis (AS) between September 2008 and December 2011. Data were acquired from a multicenter Israeli registry and the median follow up time was 5.6 years. In 184 patients (40.9%) who survived 5 years, prostheses displayed sustained hemodynamic performance, with average peak and mean aortic valve gradients of 16.2 ± 8.9 and 9.2 ± 6.6 mm Hg, respectively. Late structural valve deterioration was found in 22 (12.3%) patients. Of these, 16 (8.9%) experienced valve deterioration and 6 (3.3%) experienced valve failure. Among the 6 patients with bioprosthetic valve failure, only 3 underwent re-interventions. Bioprosthetic valve dysfunction occurred more frequently in patients with small valves (23 mm) and high peak and mean transvalvular gradients at baseline. In conclusion, a relatively low rate of valve deterioration or failure was noted in our long-term follow-up study after TAVI procedures with both the catheter-based self-expandable and balloon-expandable prosthetic valves.