Long-term results of transcatheter aortic valve replacement in degenerated surgical aortic valves-a propensity score matched analysis.

Background: The aim of this study was to analyse long-term valve function and all-cause mortality of patients undergoing transcatheter aortic valve replacement (TAVR) due to degenerated surgical aortic valve (SAV) bioprostheses.

Methods: In this single-center study, all consecutive patients undergoing TAVR between December 2012 and December 2020 were included. Long-term echocardiographic results, functional status and 5-year all-cause mortality were analysed in patients with TAV-in-SAV and native valve TAVR in a propensity score matched analysis.

Results: Out of 3423 patients who were eligible for the study, 136 experienced bioprosthetic valve dysfunction, whereas 3287 patients underwent native valve TAVR. After 2:1 propensity score matching, baseline characteristics without relation to prior SAVR were comparable between both groups. Regarding 5-year all-cause mortality, no difference was observed between patients with prior SAVR and native valve TAVR, in either unadjusted analysis, or after propensity score matching (corresponding hazard ratio: 0.95, 95% CI: 0.70-1.30, p = 0.75). In addition, while pressure gradients were higher in patients with TAV-in-SAV in long-term echocardiographic follow-up, moderate or severe hemodynamic valve deterioration did not occur more often in this group.

Conclusions: In this propensity score matched analysis, long-term all-cause mortality and echocardiographic valve function of patients with TAVR in prior bioprosthesis were comparable to patients with native valve TAVR.