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Publications

Journal Article Ahead of print

PubMed: 42635326 DOI: 10.1161/CIRCINTERVENTIONS.126.016892

Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement.

Circ Cardiovasc Interv

Authors: Antonin Trimaille, Pedro Cepas-Guillén, Marina Urena, Alberto Alperi, Gabriela Veiga-Fernandez, Luis Nombela-Franco, Victoria Vilalta, Maria Del Trigo, Antonio J Muñoz-García, Giovanni Esposito, Vincent Auffret, David Del Val, Vicenç Serra, Jorge Nuche, Lluis Asmarats, Ander Regueiro, Adrien Carmona, Quentin Fisher, Pablo Avanzas, Víctor Fradejas-Sastre, Ivan Sanchez, Michele Trichilo, Juan Francisco Oteo, Anna Franzone, Maxime Nolf, Fernando Alfonso, Pedro Díaz Pockels, Rocío Rodríguez-Santolino, Dabit Arzamendi, Eduardo Flores-Umanzor, Olivier Morel, Marisa Avvedimento, Josep Rodés-Cabau

Affiliations

  • Quebec Heart & Lung Institute, Laval University, Canada (A.T. P.C.-G. M.A. J.R.-C.).
  • Department of Cardiovascular Medicine, Nouvel Hôpital Civil Strasbourg University Hospital, France (A.T. A.C. O.M.).
  • Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (P.C.-G. A.R. E.F.-U.).
  • Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (M.U. Q.F.).
  • Área del Corazón. Hospital Universitario Central de Asturias, Oviedo, Spain (A.A. P.A.).
  • Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain (A.A. P.A.).
  • Cardiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain (G.V.-F. V.F.-S.).
  • Cardiology Department, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F. I.S.).
  • Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain (V.V. M. Trichilo).
  • Cardiology Department, Hospital Puerta de Hierro, Madrid, Spain (M. del Trigo, J.F.O.).
  • Cardiology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain (A.J.M.-G.).
  • Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.E. A.F.).
  • Department of Cardiology, University of Rennes, Rennes University Hospital, France (V.A. M.N.).
  • Cardiology Department, Hospital de La Princesa, Madrid, Spain (D.V. F.A.).
  • Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain (V.S. P.D.P.).
  • Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, Spain (J.N. R.R.-S.).
  • Centro de Investigación Biomédica En Red de enfermedades CardioVasculares (CIBERCV), Madrid, Spain (J.N. R.R.-S.).
  • Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain (L.A. D.A.).

Abstract

BACKGROUND

Data on the long-term incidence and clinical impact of bioprosthetic valve failure (BVF) after transcatheter aortic valve replacement remain limited. This study aimed to assess the incidence, predictors, and clinical impact of BVF following transcatheter aortic valve replacement.

METHODS

We analyzed data from an international, multicenter registry including consecutive patients undergoing transcatheter aortic valve replacement at 13 centers. The primary outcome was BVF according to Valve Academic Research Consortium-3 criteria. The cumulative incidence of BVF was estimated using a competing-risk approach. The association between BVF and clinical outcomes was assessed using competing-risk models with BVF as a time-dependent covariate.

RESULTS

Among 7501 patients, BVF occurred in 380 (5.1%) patients over a median follow-up of 4 (interquartile range, 2-5) years. The cumulative incidence of BVF increased over time, reaching 1.4% at 1 year, 4.6% at 5 years, and 8.3% at 10 years. Independent predictors of BVF included younger age, smoking, balloon-expandable valve, prosthesis size <26 mm, valve-in-valve procedure, mean gradient at discharge ≥15 mm Hg, moderate or severe aortic regurgitation at discharge, and early hemodynamic valve deterioration. BVF was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 1.72 [95% CI, 1.47-2.01]; P<0.001), cardiovascular mortality (adjusted hazard ratio, 3.23 [95% CI, 2.73-3.82]; P<0.001), stroke (adjusted hazard ratio, 2.08 [95% CI, 1.02-4.23]; P=0.043), and heart failure hospitalization (adjusted hazard ratio, 1.43 [95% CI, 1.03-1.98]; P=0.032). Consistent findings were observed in different sensitivity analyses.

CONCLUSIONS

BVF is a clinically relevant event associated with adverse long-term outcomes. These findings support the implementation of tailored surveillance and preventive strategies to mitigate BVF-related risk.

MeSH

Mortality, Cardiovascular Surgical Procedures, Stroke, Incidence, Heart Failure, Aortic Valve, Transcatheter Aortic Valve Replacement, Patient Discharge, Smoking