What new valve-in-valve TAVR data tell us about valve durability

Some bioprosthetic valves used for surgical aortic valve replacement (SAVR) appear to be much more durable than others, according to a new analysis published in the American Journal of Cardiology.

Researchers tracked 188 patients who underwent valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) for a failed surgical valve from January 2013 to December 2019. The mean time to valve replacement was 11.4 years, though that ranged from just barely more than one year for one patient to nearly 27 for another. While 61.1% of valves lasted more than 10 years, 30.9% lasted between five and 10 years and 8% lasted less than five years.

Overall, homograft surgical valves had the best durability with a mean time to replacement of 16.6 years. After homograft valves, pericardial stented valves were the most durable (11.9 years).  Meanwhile, bovine leaflet/porcine covered valves were the least durable (6 years).

Age, diabetes and smoking were all also found to be “significant predictors” of reduced valve durability among SAVR patients.

“Future studies should employ head-to-head randomized comparison with larger sample size, adequate follow-up duration, and standardized definitions for structural valve deterioration to derive conclusions that inform surgical and interventional practices,” wrote lead author Abdelrahman I. Abushouk, MD, a cardiovascular medicine specialist at Cleveland Clinic, and colleagues.

The full study is available here.

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