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A study today will report that since the first human percutaneous insertion of a heart valve by Professor Alain Cribier in 2002,1 there has been a major reduction in complications associated with transcatheter aortic valve implantation (TAVI) and the implanted valves show no deterioration over 10 years of use (Abstract 4069).
“Since 2002, there has been an improvement in the structure of the prosthetic implants and the number of procedures carried out continues to grow rapidly,” explains first author, Doctor Guillaume Avinée (Rouen University Hospital, Rouen, France). “However, there are few reports available on long-term patient outcome and valve durability.”
The study involved 1,530 patients with aortic stenosis receiving TAVI at Rouen University Hospital between 2002 and 2018. Transfemoral implantation (93%) with a balloon-expandable prosthesis (around 84%) was the most common approach. There was a significant reduction in vascular complications and stroke at one month to <1.0% in both cases over time. Of note, 30-day mortality fell to below 3% from 2015, reaching 2% in 2018.
“The duration of hospital stay has also decreased,” says Dr. Avinée. “The median duration was just two days in 2018, with 80% of patients being discharged within three days of the procedure.” Commenting on valve durability, a member of the original 2002 implant team and senior author of this abstract, Professor Hélène Eltchaninoff (Rouen University Hospital, Rouen, France), says, “Valves remained haemodynamically stable and only five patients showed severe valve deterioration: four went on to undergo successful valve-in-valve replacement. In some patients treated for over 10 years, the valve continues to perform well, without warning signs of wear.”
The age at which patients undergo a procedure has remained relatively stable at around 84 years. “While we expect to see expansion of the procedure around this age, until there are more long-term data on valve durability, we do not think that it is generally suitable for patients below the age of 70 years,” says Prof. Eltchaninoff. Of course, co-morbidities and risks of surgery need to be taken into account.
15 years of TAVI: Increasing evidence for routine use
Today, 14:30-15:30; Zagreb - Village 6
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