Hemodynamic Valve Deterioration After Transcatheter Aortic Valve Replacement: Incidence, Predictors, and Clinical Outcomes.

Summary

In 2,403 patients with follow-up up to 10 years, moderate or severe HVD occurred in 2.2%, 10.8%, and 25.6% at 1, 5, and 10 years, respectively. Independent predictors included higher aortic valve calcium (HR 1.81), residual aortic regurgitation (HR 1.87), and oral anticoagulant therapy (HR 1.78). HVD increased repeat valve intervention (rate ratio 4.81) without increasing mortality.

Key Findings

• Cumulative incidence of moderate/severe HVD: 2.2% (1 year), 10.8% (5 years), 25.6% (10 years).
• Independent predictors: aortic valve complex calcium volume (HR 1.81), residual AR at discharge (HR 1.87), and oral anticoagulation (HR 1.78).
• HVD associated with higher repeat aortic valve intervention (rate ratio 4.81) but similar all-cause and cardiovascular mortality.

Clinical Implications

Minimize residual AR and consider calcium burden during planning to reduce HVD risk. Structured surveillance is warranted, and patients with HVD need closer monitoring for potential reintervention.

Limitations

• Single-country registry; residual confounding inherent to observational design
• Median follow-up was relatively short; long-term estimates rely on cumulative incidence modeling

Future Directions

Test procedural strategies to reduce residual AR; evaluate anti-calcification or leaflet-thrombus prevention approaches; integrate predictors into personalized surveillance algorithms.