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Assessment of Long-Term Structural Deterioration of Transcatheter Aortic Bioprosthetic Valves Using The New European Definition: a Multicenter French Study
Eric Durand1, Anastasia Sokoloff1, Marina Urena-Alcazar2, Bernard Chevalier3, Stephan Chassaing4, Romain Didier5, Christophe Tron1, Pierre-Yves Litzler1, Claire Bouleti2, Dominique Himbert2, Thomas Hovasse3, Olivier Bar4, Guillaume Avinée1, Bernard Iung6, Didier Blanchard4, Martine Gilard5, Alain Cribier1, Thierry Lefevre1, Helene Eltchaninoff1.
1CHU de Rouen, Rouen, France, 2Bichat Hospital, Paris, France, 3Institut Hospitalier Jacques Cartier, Massy, France, 4Clinique Saint Gatien, Tours, France, 5CHU de Brest, Brest, France, 6Bichat Hospital, Rouen, France.

Objectives: The durability of transcatheter aortic bioprosthetic valves is a crucial issue, but data are scarce, especially beyond 5 years of follow-up. We aimed to assess long-term (7 years) structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) of transcatheter aortic bioprosthetic valves. Methods: Consecutive patients with at least 5-year follow-up available undergoing transcatheter aortic valve implantation (TAVI) patients from April 2002 to December 2011 in 5 French centers were included. Incidence of SVD and BVF were defined according to newly standardized European Association of Percutaneous Cardiovascular Interventions/European Society of Cardiology/European Association for Cardio-Thoracic Surgery criteria and was reported as cumulative incidence function to account for the competing risk of death. Results: 1,403 consecutive patients were included with a mean age of 82.6±7.5 years and with a mean logistic EuroSCORE of 21.3±7.5%. Survival rates were 83.5% (95%CI: 81.4-85.5%) and 18.6% (95%CI: 15.3-21.8%) at 1 and 7 years, respectively. BVF occurred in 19 patients with a 7-year cumulative incidence of 1.9% (95%CI: 1.4-2.4%). SVD occurred in 49 patients (moderate, n=32; severe, n=17) with a 7-year cumulative incidence of moderate and severe SVD of 7.0% (95%CI: 5.6-8.4%) and 4.2% (95%CI: 2.9-5.5%), respectively. Five patients had aortic valve re-intervention (1.0%; 95%CI: 0.4-1.6%) including one case of surgical aortic valve replacement and 4 redo-TAVI. Conclusions: Our data do not raise any alarm signals concerning the durability of transcatheter aortic bioprosthetic valves. Further studies are warranted to assess the long-term durability of transcatheter aortic bioprosthetic valves particularly in younger and lower-risk patients.


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