A new study published in The Annals of Thoracic Surgery, a journal from The Society of Thoracic Surgeons, has identified early hemodynamic valve deterioration (HVD) in more than 6% of patients just one year after undergoing transcatheter aortic valve implantation (TAVI), raising new questions about valve durability in younger, lower-risk populations.
The retrospective study, which analyzed 10 years of procedures from 2012 to 2022, evaluated 2,123 patients who had complete echocardiographic follow-up data. Researchers found that patients with 1-year HVD were more likely to be younger and have smaller aortic annuli than those without HVD. Importantly, smaller implanted valve sizes were significantly associated with the development of HVD, while larger valves appeared to be protective.
"As TAVI is increasingly used in younger and healthier patients, our findings suggest a need to carefully consider valve sizing and long-term durability," said lead study author Eishan Ashwat, BS, a medical student at the University of Pittsburgh School of Medicine. "Early identification of hemodynamic deterioration may serve as a key predictor of future reintervention and patient outcomes."
According to the study, patients with 1-year HVD had a five-year aortic valve reintervention rate nearly four times higher than those without HVD (2.3% vs. 0.6%). Prior surgical aortic valve replacement (AVR) was also independently associated with a higher risk of early HVD.
The findings underscore the importance of vigilant long-term follow-up and may influence future decision-making regarding valve selection, particularly in patients with smaller aortic anatomy or a history of AVR.
The study used the updated Valve Academic Research Consortium-3 (VARC-3) definitions to assess bioprosthetic valve function and structural deterioration.
