Key result
TAVR shows encouraging mid-term durability but long-term structural valve deterioration remains unknown versus surgical valves.
Why the study?
Bioprosthetic valve durability and structural valve deterioration are main limitations, and long-term durability of transcatheter heart valves remains largely unknown as use expands to younger, lower-risk patients.
Systematic Review
This systematic review highlights that while mid-term durability of TAVR is encouraging, long-term structural valve deterioration data is still needed as indications expand to younger, lower-risk patients.
Caution advised before expanding TAVR to younger patients; leaves open long-term durability versus surgery.
Mechanical valves and bioprosthetic heart valves are widely used for aortic valve replacement (AVR). Mechanical valves are associated with risk of bleeding because of oral anticoagulation, while the durability and structural valve deterioration (SVD) represent the main limitation of the bioprosthetic heart valves. The implantation of bioprosthetic heart valves is increasing precipitously due aging population, and the widespread use of transcatheter aortic valve replacement (TAVR). TAVR has become the standard treatment for intermediate or high surgical risk patients and a reasonable alternative to surgery for low risk patients with symptomatic severe aortic stenosis. Moreover, TAVR is increasingly being used for younger and lower-risk patients with longer life expectancy; therefore it is important to ensure the valve durability for long-term transcatheter aortic valves. Although the results of mid-term durability of the transcatheter heart valves are encouraging, their long-term durability remains largely unknown. This review summarises the definitions, mechanisms, risk factors and assessment of SVD; overviews available data on surgical bioprosthetic and transcatheter heart valves durability.
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Okutucu et al. (2020) conducted a systematic review in severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) vs. Surgical bioprosthetic heart valves was evaluated on Structural valve deterioration (SVD) and durability. Transcatheter aortic valve replacement demonstrates encouraging mid-term durability, though long-term structural valve deterioration rates remain largely unknown compared to surgical valves.
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