Hemodynamic durability of transcatheter aortic valves using the updated Valve Academic Research Consortium‐2 criteria

Abstract

Objectives We investigated the hemodynamic durability of the transcatheter aortic valves (TAVs) using the updated Valve Academic Research Consortium‐2 (VARC‐2) criteria. Background The updated VARC‐2 consensus criteria combine flow‐dependent and flow‐independent echocardiographic parameters for hemodynamic assessment of TAVR. Data on the hemodynamic durability of TAV and clinical risk factors associated with valve hemodynamic deterioration (VHD) are lacking. Methods All patients (n = 276) who received TAV between 2006 and 2012 and had ≥2 follow‐up echocardiograms were studied. Results During a median follow up period of 3.3 (1.8‐4.4) years, 8 patients (3%) developed moderate to severe valve stenosis per the VARC‐2 criteria, while 20 had mild stenosis. In a Cox proportional hazards model analysis, moderate to severe stenosis by VARC‐2 criteria was associated with younger age (P = 0.03, HR 0.94), absence of dual antiplatelet therapy (DAPT) (P = 0.026, HR 0.18), and lower baseline left ventricular ejection fraction (LVEF) (P = 0.006, HR 0.94). Longitudinal analysis using a mixed effect model showed that presence of stenosis by VARC‐2 criteria was associated with an increase in aortic valve mean gradient (P < 0.001, +2.34 mmHg per year). In a subset of 93 patients with analyzable fluoroscopic images, deeper valve implantation was associated with increase in mean gradient (P = 0.004, +0.2 mmHg per year per 1 mm increase in implantation depth). Conclusion Despite good hemodynamic durability of TAV, patients with younger age, lower LVEF and those not on DAPT after undergoing a TAV replacement, are at a higher risk for development of VHD.

Transcatheter Aortic Valve Implantation in Severe Native Pure Aortic Regurgitation Following Endocarditis With Large Vegetation

“…Our preference was to use a self-expanding valve to allow significant oversizing while limiting the risk of annular rupture; we therefore elected to use a 34-mm TAVI, which is suitable for up to a 30-mm annular diameter and a 94.2-mm perimeter. Use of this valve in native pure AR (NPAR) has been previously reported in small numbers of patients with reasonable success rates ( 2 ).…”

“…It is important to acknowledge that across all studies of TAVI for NPAR, the success rates are considerably lower than contemporary trials of TAVI for AS. Three recent studies reported device success rates ranging from 74.3% to 85% according to Valve Academic Research Consortium (VARC-2) criteria ( 2 , 4 , 5 , 6 ). The main reported complications were high rates of second valve implantation and significant post-procedural AR.…”

Adverse clinical outcomes in patients undergoing both PCI and TAVR: Analysis from a pooled multi‐center registry

“…Current expert consensus recommends antiplatelet therapy following TAVR to reduce risk of stroke 17 . A previous report also showed that antiplatelet therapy, but not anti‐coagulation was associated with lower risk of valve degeneration after TAVR 18 . The GALILEO trial (NCT02556203) was halted when early data demonstrated that an anticoagulation (Rivaroxaban) strategy after TAVR was associated with higher incidence of death, bleeding and thromboembolic events when compared to antiplatelet based strategy.…”

TAVI for Pure Native Aortic Regurgitation: Are We There Yet?

“…Overall device success according to Valve Academic Research Consortium (VARC-2) criteria was 67%, being higher with NGD (82% versus 47% when compared with EGD). [9] NGD use was associated with less valve malpositioning and less moderate to severe post-procedural AR. Cardiovascular mortality was also lower with NGD.…”

“…This leaves unanswered questions about valve durability; as far as we know the incidence of structural valve deterioration after 5 years is very low, but information beyond this time is scarce. [9–12]…”