Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement

BACKGROUND: Data on the long-term incidence and clinical impact of bioprosthetic valve failure (BVF) after transcatheter aortic valve replacement remain limited. This study aimed to assess the incidence, predictors, and clinical impact of BVF following transcatheter aortic valve replacement. METHODS: We analyzed data from an international, multicenter registry including consecutive patients undergoing transcatheter aortic valve replacement at 13 centers. The primary outcome was BVF according to Valve Academic Research Consortium-3 criteria. The cumulative incidence of BVF was estimated using a competing-risk approach. The association between BVF and clinical outcomes was assessed using competing-risk models with BVF as a time-dependent covariate. RESULTS: Among 7501 patients, BVF occurred in 380 (5.1%) patients over a median follow-up of 4 (interquartile range, 2–5) years. The cumulative incidence of BVF increased over time, reaching 1.4% at 1 year, 4.6% at 5 years, and 8.3% at 10 years. Independent predictors of BVF included younger age, smoking, balloon-expandable valve, prosthesis size <26 mm, valve-in-valve procedure, mean gradient at discharge ≥15 mm Hg, moderate or severe aortic regurgitation at discharge, and early hemodynamic valve deterioration. BVF was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 1.72 [95% CI, 1.47–2.01]; P <0.001), cardiovascular mortality (adjusted hazard ratio, 3.23 [95% CI, 2.73–3.82]; P <0.001), stroke (adjusted hazard ratio, 2.08 [95% CI, 1.02–4.23]; P =0.043), and heart failure hospitalization (adjusted hazard ratio, 1.43 [95% CI, 1.03–1.98]; P =0.032). Consistent findings were observed in different sensitivity analyses. CONCLUSIONS: BVF is a clinically relevant event associated with adverse long-term outcomes. These findings support the implementation of tailored surveillance and preventive strategies to mitigate BVF-related risk.

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Journal
Circulation Cardiovascular Interventions
Published
2026-08-24
DOI
https://doi.org/10.1161/circinterventions.126.016892
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement

Fernándo Alfonso, Victòria Vilalta, Lluís Asmarats, Eduardo Flores‐Umanzor et al.
Circulation Cardiovascular Interventions
Cardiac Valve Diseases and Treatments
article

Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement

Fernándo Alfonso, Victòria Vilalta, Lluís Asmarats, Eduardo Flores‐Umanzor, Pedro Cepas‐Guillén, David del Val, Marina Ureña, Josep Rodés‐Cabau, Adrien Carmona, Olivier Morel, Jorge Nuche, Víctor Fradejas-Sastre, Dabit Arzamendi, Quentin Fischer, Marisa Avvedimento, Luis Nombela‐Franco, Antonin Trimaille, Gabriela Veiga Fernández, Giovanni Esposito, Pablo Avanzas, Alberto Alperi, Anna Franzone, Vincent Auffret, Rocío Rodríguez-Santolino, María Del Trigo, J. Domínguez, Vicenç Serra, Pedro Diaz Pockels, Maxime Nolf, Michele Trichilo, Antonio J. Muñoz-García, Ander Regueiro, Ivan Sanchez
article en

Abstract

BACKGROUND: Data on the long-term incidence and clinical impact of bioprosthetic valve failure (BVF) after transcatheter aortic valve replacement remain limited. This study aimed to assess the incidence, predictors, and clinical impact of BVF following transcatheter aortic valve replacement. METHODS: We analyzed data from an international, multicenter registry including consecutive patients undergoing transcatheter aortic valve replacement at 13 centers. The primary outcome was BVF according to Valve Academic Research Consortium-3 criteria. The cumulative incidence of BVF was estimated using a competing-risk approach. The association between BVF and clinical outcomes was assessed using competing-risk models with BVF as a time-dependent covariate. RESULTS: Among 7501 patients, BVF occurred in 380 (5.1%) patients over a median follow-up of 4 (interquartile range, 2–5) years. The cumulative incidence of BVF increased over time, reaching 1.4% at 1 year, 4.6% at 5 years, and 8.3% at 10 years. Independent predictors of BVF included younger age, smoking, balloon-expandable valve, prosthesis size <26 mm, valve-in-valve procedure, mean gradient at discharge ≥15 mm Hg, moderate or severe aortic regurgitation at discharge, and early hemodynamic valve deterioration. BVF was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 1.72 [95% CI, 1.47–2.01]; P <0.001), cardiovascular mortality (adjusted hazard ratio, 3.23 [95% CI, 2.73–3.82]; P <0.001), stroke (adjusted hazard ratio, 2.08 [95% CI, 1.02–4.23]; P =0.043), and heart failure hospitalization (adjusted hazard ratio, 1.43 [95% CI, 1.03–1.98]; P =0.032). Consistent findings were observed in different sensitivity analyses. CONCLUSIONS: BVF is a clinically relevant event associated with adverse long-term outcomes. These findings support the implementation of tailored surveillance and preventive strategies to mitigate BVF-related risk.

Circulation Cardiovascular Interventions
Université Claude Bernard Lyon 1 (FR), Hebron University (PS), Hospital de Sant Pau (ES), Hospital Clínico San Carlos (ES), Université Rennes 2 (FR), Research Institute Hospital 12 de Octubre (ES), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (ES), Lung Institute (US), Hospital Universitario 12 De Octubre (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Instituto de Investigación Marqués de Valdecilla (ES), Centro de Investigación Biomédica en Red (ES), Federico II University Hospital (IT), Vall d'Hebron Hospital Universitari (ES), Hospital Universitario de La Princesa (ES), Hospital Universitario Central de Asturias (ES), Hôpital Bichat-Claude-Bernard (FR), Hospital Universitari Germans Trias i Pujol (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Hôpital Civil, Strasbourg (FR), Instituto de Investigación Sanitaria del Principado de Asturias (ES), Université de Rennes (FR)
Good health and well-being
Openalex Percentile: Top 10%
Cardiac Valve Diseases and Treatments
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