Structural valve deterioration (SVD) is a condition where the implanted valve in the heart fails to function properly. This study aimed to understand the frequency, clinical outcomes, and predictors of hemodynamic SVD in patients undergoing self-expanding transcatheter aortic valve implantation (TAVI) or surgery. The study analyzed data from four trials, including 4,762 patients with severe aortic valve stenosis who were at intermediate or increased risk of surgical mortality. Data were collected from December 2010 to June 2016, and analyzed from December 2021 to October 2022.
The primary endpoint of the study was the incidence of SVD through 5 years, and the study found a lower rate of SVD in patients undergoing self-expanding TAVI vs. surgery at 5 years. Of the included patients, 2,099 received TAVI and 1,971 underwent surgery. The lower risk was most pronounced in patients with smaller annuli (23 mm diameter or smaller). SVD was associated with increased 5-year all-cause mortality, cardiovascular mortality, and valve disease or worsening heart failure hospitalizations.
The study concluded that Doppler echocardiography was a valuable tool to detect SVD, which was associated with worse clinical outcomes. The study’s findings suggest that self-expanding TAVI may be a more effective option for patients with severe aortic valve stenosis at intermediate or increased risk of surgical mortality. This study is significant as it provides insights into the frequency and clinical outcomes of SVD in patients undergoing TAVI or surgery and emphasizes the importance of early detection and management of SVD to improve patient outcomes.
doi:10.1001/jamacardio.2022.4627
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