Key result
Following TAVR, explanted native aortic valves and neo-sinuses from 20 patients showed ongoing calcific aortic stenosis-like disease activity and extensive architectural remodeling over up to 7 years.
Why the study?
Data are limited on the progression of native valve disease post-TAVR, and there has been no previous analysis of the native neo-sinus.
Does TAVR result in ongoing disease activity and remodeling in the native aortic valve and native neo-sinus?
Observational (n=20)
Does TAVR result in ongoing disease activity and remodeling in the native aortic valve and native neo-sinus?
Post-TAVR, native leaflets and the neo-sinus undergo ongoing calcific disease activity and extensive remodeling, potentially impacting valve degeneration and future re-interventions.
Answers are grounded in this paper and cite their sources.
Ongoing native neo-sinus remodeling post-TAVR may affect durability and reintervention; hypothesis-generating in small explant series, prospective studies needed.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) pushes aside the diseased native aortic valve and creates a native neo-sinus bordered by the aortic root wall and the displaced native valve. There are limited data on the progression of native valve disease post-TAVR and no previous analysis of the native neo-sinus. METHODS: Native aortic valves and native neo-sinus explants obtained post-TAVR were evaluated histologically (hematoxylin and eosin, Movat pentachrome, and Martius Scarlet Blue stains) and by immunohistochemistry (TGF-β1 [transforming growth factor-beta 1], FAP [fibroblast activation protein], and ALP [alkaline phosphatase]) to assess disease mechanisms. RESULTS: Native aortic valves were obtained from 20 patients from 0 to 2583 days (7.08 years) post-TAVR. Native leaflets showed persistent calcific aortic stenosis-like disease activity with positivity for ALP and FAP. Native valve remodeling was observed as changes in architecture evident in explants >1.5 years, which was observed as crumpling of the leaflets. Disease activity was also present in native neo-sinuses with transcatheter heart valve implant durations >1 year with positive staining for TGF-β1, FAP, and ALP. Extensive native neo-sinus remodeling occurred with replacement and filling-in of this space with contiguous extracellular matrix, calcific deposits, and microvessels. CONCLUSIONS: Following TAVR, there is ongoing calcific aortic stenosis-like disease with architectural changes to native leaflets and extensive remodeling of the native neo-sinus, evidenced by replacement and contiguous filling-in of the native neo-sinus blood pool space with increasing implant duration. The dynamic nature of these tissues has potential implications for neo-sinus flow, valve degeneration, and re-intervention.
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Yoon et al. (2024) conducted an observational in Post-Transcatheter Aortic Valve Replacement (n=20). Transcatheter aortic valve replacement (TAVR) was evaluated on Histological and immunohistochemical evaluation of native valve and neo-sinus remodeling. Following TAVR, explanted native aortic valves and neo-sinuses from 20 patients showed ongoing calcific aortic stenosis-like disease activity and extensive architectural remodeling over up to 7 years.
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