Durability of transcatheter aortic valves, current evidence and future prospective

Abstract

Transcatheter aortic valve implantation (TAVI) has become a safe and valid procedure in all surgical risk patients, expanding TAVI indications to a larger number of patients. However, while short- and mid-term follow up showed similar results compared to surgery, long-term durability remains unstudied. Concerns about TAVI longevity are mainly raised by early development of higher rates of bioprosthetic valve disfunction (BVD) and especially of paravalvular leaks (PVL), which have been previously related with long-term mortality. In this context, the definition of BVD, its relationship with the TAVI technology (balloon vs. self-expandable), and the prognostic role of mild PVL are a complex topic which has not been clarified yet, along with outcomes of valve-in-valve (ViV) intervention, which represents a valid therapeutic option in the case of severe BVD. The aim of this narrative review is to offer a general overview of the evolution of TAVI indications; show the differences between balloon and self-expandable prostheses performances; clarify the definition, classification, and prognostic role of BVD; and summarize current evidence about long-term TAVI durability.

Keywords

Aortic stenosis / transcatheter aortic valve implantation / TAVI durability / bioprosthetic valve degeneration / transcatheter aortic valve in valve

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