TCT-478 Long-Term 10 Years’ Follow-Up for Valve Dysfunction and Mean Gradient Change in Transcatheter Aortic Valve Replacement (TAVR)

Abstract

Background: The long-term follow-up for valve dysfunction in transcatheter aortic valve replacement (TAVR) and need for intervention over 10 years are still unknown. This study followed the echocardiographic measurement of gradient change and the need for valve intervention up to 10 years after implantation. Previous reports up to 8 years of follow-up were reported. Methods: All patients who underwent a TAVR procedure between January 2011 and December 2014 were included in a large main cardiac center in Riyadh, Saudi Arabia. Patients with echocardiogram follow-up studies within the study period were included. Valve dysfunction, using Valve Academic Research Consortium-3 criteria, was defined as the formation of thrombosis or pannus within the valve, change in gradient >10 mm Hg, or leaflet tear/perforation. Incidence of function deterioration and causes of death were collected. Results: A total of 179 patients (age 77.86 ± 8.4 years; 39.89% female) were analyzed and divided according to the type of valve: implanted self-expanding valve (SEV) 125 (70.22%) vs balloon-expanding valve (BEV) 53 (29.78%). The prevalence of hypertension, diabetes, and dyslipidemia was 80.2%, 60.5%, and 55.0%, respectively. Overall, patients had a high (8.11%) Society of Thoracic Surgeons mean score. Over the median follow-up of 4.8 (2.3-7.2) years, the reintervention rate was 2.7% for valve dysfunction (2 BEV, 3 SEV), including 3 stenosed valves, 1 infective endocarditis, and 1 severe paravalvular leak. Incidence of valve thrombosis was 0.55% (BEV size 26), and gradient change (≥10 mm Hg) was 12 (9.38%) where 7 patients categorized as moderate >10 mm Hg increase in mean gradient and 5 patients were categorized as Sever >20 mm Hg mean gradient increase. Conclusion: In this study, older generation SEV and BEV had a rate of reintervention for structural valve deterioration of 2.7% despite older generation valve leaflet and design. The incidence of valve thrombosis or endocarditis appears to be <1%. Categories: STRUCTURAL: Valvular Disease: Aortic