Résumé
Introduction: valve durability after transcatheter aortic valve implantation (TAVI) is an important issue since the increase of implantations and the extension of indications. This study aimed to assess long-term evolution of all generations of percutaneous balloon-expandable prostheses, predictive factors of valve deterioration and long-term mortality. Material and methods: all patients with severe and symptomatic aortic stenosis hospitalized in Montpellier University Hospital from 2009 at 2014 for TAVI with a balloon-expandable valve were included in this observational prospective study. Primary endpoint was the occurrence of death from acute heart failure or valvular deterioration defined by the international 2017 EAPCI-‐ESC-‐EACTS standardized definition. Results: with a median 3.4-year follow-up and a maximal follow-up of 8 years, 203 consecutive patients were included. Median age was 85 years [IQR 79-‐88], with 55.2% of women and a median logistic EuroSCORE of 14.4% [IQR 10.7-‐23.2]. Mean aortic gradient decreased dramatically from 50.3±15.7mmHg before TAVI to 8.9±3.4mmHg after TAVI (p<0.0001) with a global stability up to 8 years independently of valve generation. Primary endpoint occurred in 29 patients (18.1%) with 9 cases of valvular deterioration (5.6%) without significant difference between first and latest valve generation. Survival rate was 12.9% at 8 years. Conclusion: valvular deterioration after balloon-expandable TAVI is very low up to 8-year follow-up. In a high-risk population, TAVI is a safe and durable alternative to surgery to treat aortic stenosis.