Early transcatheter valve prosthesis degeneration and future ramifications

Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for patients with severe, symptomatic aortic stenosis with prohibitive risk for valve replacement surgery (SAVR) and is now considered a favourable alternative to surgical management for patients considered to be high risk (1). Recently published results of the PARTNER 2 trial have demonstrated that TAVR is an acceptable treatment option for patients with intermediate surgical risk and may hold an advantage over surgery if feasible via transfemoral approach (2). As we continue to explore the possibility of TAVR for lower risk patients who are typically younger and good candidates for surgical therapy, the durability of the prosthesis becomes an important consideration. Bioprosthetic valve failure after surgical aortic valve replacement (SAVR) is well described and well investigated. Structural valve deterioration is the most common noted cause with incidence of <1%, 10–30%, and 20–50% at 1, 10 and 15 years respectively (3,4). A recent report highlighting concerns regarding the long-term durability of the early SAPIEN prosthesis has certainly compelled the structural heart community to take a step back and better evaluate the future of TAVR for patients at low surgical risk (5). Currently, clinical trials are recruiting patients in the United States to examine the efficacy of TAVR in low risk patients, both studying the Medtronic CoreValve Evolut R System (NCT02701283) and the Edwards S3 system (PARTNER 3 trial, NCT02675114).