Key result
TAVI matches surgery for mid-term outcomes, but long-term durability and valve dysfunction remain uncertain.
Level 5 evidence in vascular journal; leaves open need for confirmatory trials before clinical consideration.
Transcatheter aortic valve implantation (TAVI) has become a safe and valid procedure in all surgical risk patients, expanding TAVI indications to a larger number of patients. However, while shortand mid-term follow up showed similar results compared to surgery, long-term durability remains unstudied. Concerns about TAVI longevity are mainly raised by early development of higher rates of bioprosthetic valve disfunction (BVD) and especially of paravalvular leaks (PVL), which have been previously related with long-term mortality. In this context, the definition of BVD, its relationship with the TAVI technology (balloon vs. self-expandable), and the prognostic role of mild PVL are a complex topic which has not been clarified yet, along with outcomes of valve-in-valve (ViV) intervention, which represents a valid therapeutic option in the case of severe BVD. The aim of this narrative review is to offer a general overview of the evolution of TAVI indications; show the differences between balloon and self-expandable prostheses performances; clarify the definition, classification, and prognostic role of BVD; and summarize current evidence about long-term TAVI durability.
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Marengo et al. (2021) conducted a review in Aortic valve disease / Bioprosthetic valve dysfunction (BVD). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) / Balloon vs. self-expandable prostheses was evaluated on Long-term valve durability and bioprosthetic valve dysfunction (BVD). Transcatheter aortic valve implantation shows similar short- and mid-term outcomes to surgery, but long-term durability and bioprosthetic valve dysfunction remain unclarified in this narrative review.
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