Long-Term UK TAVI Data Demonstrate Durability of Devices

February 8, 2019—Long-term findings from UK TAVI, the United Kingdom Transcatheter Aortic Valve Implantation study, were published by Daniel J. Blackman, MD, et al in Journal of the American College of Cardiology (JACC; 2019;73;537–545). The investigators sought to evaluate the incidence of structural valve degeneration (SVD) 5 to 10 years after transcatheter aortic valve replacement (TAVR) procedures.

The UK TAVI study showed that long-term transcatheter aortic valve function was excellent, with 91% of patients free of SVD between 5 and 10 years postimplantation with an incidence of severe SVD of < 1% and moderate SVD in one in 12 patients, concluded the investigators in JACC.

As summarized in JACC, the investigators obtained demographic, procedural, and in-hospital outcome data from the UK TAVI registry on patients who underwent TAVR from 2007 to 2011. The analysis included patients in whom echocardiographic data were available both at baseline and ≥ 5 years postprocedure. Hemodynamic SVD was determined according to European task force committee guidelines.

The long-term study was composed of 241 patients (79.3 ± 7.5 years of age; 46% women) with paired postprocedure and late echocardiographic follow-up (median 5.8 years, range 5 to 10 years). Of these subjects, 149 (64%) patients were treated with a self-expandable valve and 80 (34.7%) patients were treated with a balloon-expandable valve.

In JACC, the investigators reported the following results at long-term follow-up versus postprocedure:

• Lower peak aortic valve gradient (17.1 vs 19.1 mm Hg; P = .002)
• More patients had no or trivial aortic regurgitation (AR) (47.5% vs 33%)
• Fewer patients had mild AR (42.5% vs. 57%) (P = .02)

Additionally, the one (0.4%) case of severe SVD occurred at 5.3 years after implantation (new severe AR). Of the 21 (8.7%) cases of moderate SVD (mean 6.1 years postimplantation; range, 4.9 to 8.6 years), 12 (57%) were caused by new AR and nine (43%) were caused by restenosis, reported the investigators in JACC.