Author + information
- Received August 26, 2018
- Revision received October 23, 2018
- Accepted October 29, 2018
- Published online February 4, 2019.
- Daniel J. Blackman, MDa,∗ (, )@ryvetsprog,
- Smriti Saraf, MDa,
- Philip A. MacCarthy, PhDb,
- Aung Myat, MDc,
- Simon G. Anderson, PhDd,
- Christopher J. Malkin, MDa,
- Michael S. Cunnington, MDa,
- Kathryn Somers, BSca,
- Paul Brennan, MDe,
- Ganesh Manoharan, MDe,
- Jessica Parker, BScc,
- Omar Aldalati, MDb,
- Stephen J. Brecker, MDf,
- Cameron Dowling, MBBSf,
- Stephen P. Hoole, MDg,
- Stephen Dorman, MDh,
- Michael Mullen, MDi,
- Simon Kennon, MDi,
- Melanie Jerrum, BSci,
- Pavan Chandrala, BSci,
- David H. Roberts, MDj,
- Justin Tay, MDj,
- Sagar N. Doshi, MDk,
- Peter F. Ludman, MDk,
- Timothy A. Fairbairn, MDl,
- Joanne Crowe, BScl,
- Richard D. Levy, MDd,
- Adrian P. Banning, MDm,
- Neil Ruparelia, MDm,
- Mark S. Spence, MDe and
- David Hildick-Smith, MDc
- aDepartment of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- bDepartment of Cardiology, King’s College Hospital, London, United Kingdom
- cDepartment of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
- dDepartment of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- eDepartment of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom
- fDepartment of Cardiology, St. George's Hospital, London, United Kingdom
- gDepartment of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
- hDepartment of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
- iDepartment of Cardiology, Barts Health NHS Trust, London, United Kingdom
- jDepartment of Cardiology, Lancashire Cardiac Centre, Blackpool, United Kingdom
- kDepartment of Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom
- lDepartment of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- mDepartment of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
- ↵∗Address for correspondence:
Dr. Daniel J. Blackman, Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
Background Very little is known about long-term valve durability after transcatheter aortic valve replacement (TAVR).
Objectives This study sought to evaluate the incidence of structural valve degeneration (SVD) 5 to 10 years post-procedure.
Methods Demographic, procedural, and in-hospital outcome data on patients who underwent TAVR from 2007 to 2011 were obtained from the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) registry. Patients in whom echocardiographic data were available both at baseline and ≥5 years post-TAVR were included. Hemodynamic SVD was determined according to European task force committee guidelines.
Results A total of 241 patients (79.3 ± 7.5 years of age; 46% female) with paired post-procedure and late echocardiographic follow-up (median 5.8 years, range 5 to 10 years) were included. A total of 149 patients (64%) were treated with a self-expandable valve and 80 (34.7%) with a balloon-expandable valve. Peak aortic valve gradient at follow-up was lower than post-procedure (17.1 vs. 19.1 mm Hg; p = 0.002). More patients had none/trivial aortic regurgitation (AR) (47.5% vs. 33%), and fewer had mild AR (42.5% vs. 57%) at follow-up (p = 0.02). There was 1 case (0.4%) of severe SVD 5.3 years after implantation (new severe AR). There were 21 cases (8.7%) of moderate SVD (mean 6.1 years post-implantation; range 4.9 to 8.6 years). Twelve of these (57%) were due to new AR and 9 (43%) to restenosis.
Conclusions Long-term transcatheter aortic valve function is excellent. In the authors’ study, 91% of patients remained free of SVD between 5 and 10 years post-implantation. The incidence of severe SVD was <1%. Moderate SVD occurred in 1 in 12 patients.
This research was supported by the National Institute for Health Research (NIHR) infrastructure at Leeds. Prof. Banning is partially funded by the NHS NIHR Biomedical Research Centre Oxford. Dr. Blackman has been a consultant and proctor for Medtronic and Boston Scientific. Dr. MacCarthy has been a proctor for Edwards Lifesciences; has received research support from Boston Scientific; and has received consultancy/speaker fees from Abbott Vascular and Edwards Lifesciences. Dr. Malkin has been a proctor for Medtronic and Boston Scientific. Dr. Cunnington has received consulting fees from Boston Scientific; and sponsorship for attendance at educational meetings from Medtronic and Boston Scientific. Dr. Manoharan has been a proctor for Medtronic and Abbott. Dr. Brecker has been a consultant to and received grant support from Medtronic and Boston Scientific. Dr. Dowling has received grant support and speaker honoraria from Medtronic. Dr. Hoole has received research funding from Abbott Vascular; and has served as a proctor, on the Speakers Bureau, and/or on an advisory board for Abbott Vascular and Boston Scientific. Dr. Dorman has received sponsorship to attend educational meetings from Medtronic. Dr. Mullen has been a consultant for and received research grants from Edwards Lifesciences. Dr. Kennon has received grant support and honoraria from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Doshi has been a proctor and consultant for Edwards Lifesciences. Dr. Fairbairn has served on the Speakers Bureau for HeartFlow. Dr. Levy has been a proctor for Medtronic. Prof. Banning has received an institutional grant from Boston Scientific to fund a fellowship; and has received speakers fees from Medtronic, Boston Scientific, Phillips, and Abbott. Dr. Spence has received research funding from Edwards Lifesciences, Boston Scientific, and Medtronic; has been a consultant to Abbott, Boston Scientific, and Edwards Lifesciences; and has been a proctor for Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Hildick-Smith has been a proctor and served on advisory boards for Boston Scientific, Edwards Lifesciences, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received August 26, 2018.
- Revision received October 23, 2018.
- Accepted October 29, 2018.
- 2019 American College of Cardiology Foundation
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