Résumé
With the growing indications of trans-catheter aortic-valve implantation (TAVI) and beneficial results among lower risk patients, valve durability is become a crucial issue.
To assess long-term evolution of different generations of percutaneous balloon-expandable prostheses, incidence and predictive factors of structural valve deterioration (SVD).
All consecutive patients undergoing TAVI for severe aortic stenosis with balloon-expandable prosthesis between 2009 and 2014 were included in this monocentric prospective study. All echocardiograms were reviewed by two independent experts. Clinical events were defined according to the Valve Academic Research Consortium. SVD was defined according to the 2017 EAPCI-ESC-EACTS international consensus at the longest follow-up.
A total of 160patients were included with a median follow-up of 3.4 [1.5–4.9] years and a maximum of 8years. Patients were mostly implanted with the first generation Sapien XT valve (n=138, 86.2%). Median age was 85 [79–86] years with a median logistic Euro-SCORE of 14.2% [10.6–23.2]. Immediately after TAVI, mean aortic gradient decreased dramatically from 51±12mmHg to 9±2.6mmHg (P<0.0001) and remained stable up to 8-year with a mean gradient of 12±1mmHg. SVD occurred in 5.6% of patients, of which 3.7% with severe deterioration. Clinical impact of SVD was limited with only 2 patients (1.3%) requiring reintervention. After multivariate analysis, size or generation of valves were not independent predictive factors of SVD. The eight-year survival rate was 12.9%. During follow-up, hospitalization for acute heart failure was required for 23.7% of patients, a myocardial infarction or a stroke occurred respectively among 1.9% and 5% of patients (Fig. 1).
Up to 8-year follow-up, SVD following balloon-expandable TAVI is very low. TAVI seems to be a safe alternative to surgery in severe aortic stenosis regardless of prosthesis generation.