Background:Major uncertainties remain regarding disease activity within the retained native aortic valve, and regarding bioprosthetic valve durability, after transcatheter aortic valve implantation (TAVI). We aimed to assess native aortic valve disease activity and bioprosthetic valve durability in patients with TAVI in comparison with subjects with bioprosthetic surgical aortic valve replacement (SAVR).Methods:In a multicenter cross-sectional observational cohort study, patients with TAVI or bioprosthetic SAVR underwent baseline echocardiography, computed tomography angiography, and ¹⁸F-sodium fluoride (¹⁸F-NaF) positron emission tomography. Participants (n=47) were imaged once with ¹⁸F-NaF positron emission tomography/computed tomography either at 1 month (n=9, 19%), 2 years (n=22, 47%), or 5 years (16, 34%) after valve implantation. Patients subsequently underwent serial echocardiography to assess for changes in valve hemodynamic performance (change in peak aortic velocity) and evidence of structural valve dysfunction. Comparisons were made with matched patients with bioprosthetic SAVR (n=51) who had undergone the same imaging protocol.Results:In patients with TAVI, native aortic valves demonstrated ¹⁸F-NaF uptake around the outside of the bioprostheses that showed a modest correlation with the time from TAVI (r=0.36, P=0.023). ¹⁸F-NaF uptake in the bioprosthetic leaflets was comparable between the SAVR and TAVI groups (target-to-background ratio, 1.3 [1.2–1.7] versus 1.3 [1.2–1.5], respectively; P=0.27). The frequencies of imaging evidence of bioprosthetic valve degeneration at baseline were similar on echocardiography (6% versus 8%, respectively; P=0.78), computed tomography (15% versus 14%, respectively; P=0.87), and positron emission tomography (15% versus 29%, respectively; P=0.09). Baseline ¹⁸F-NaF uptake was associated with a subsequent change in peak aortic velocity for both TAVI (r=0.7, P<0.001) and SAVR (r=0.7, P<0.001). On multivariable analysis, ¹⁸F-NaF uptake was the only predictor of peak velocity progression (P<0.001).Conclusions:In patients with TAVI, native aortic valves demonstrate evidence of ongoing active disease. Across imaging modalities, TAVI degeneration is of similar magnitude to bioprosthetic SAVR, suggesting comparable midterm durability.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02304276.

中文翻译：

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经导管主动脉瓣植入术患者的自体主动脉瓣疾病进展和生物瓣膜变性

背景：在经导管主动脉瓣植入 (TAVI) 后，保留的天然主动脉瓣内的疾病活动性以及生物瓣膜的耐久性仍存在主要不确定性。我们的目的是评估 TAVI 患者与生物瓣手术主动脉瓣置换术 (SAVR) 患者的天然主动脉瓣疾病活动性和生物瓣膜耐久性。方法：在一项多中心横断面观察性队列研究中，TAVI 或生物瓣膜置换术患者接受了基线超声心动图、计算机断层扫描血管造影和¹⁸ F-氟化钠 ( ¹⁸ F-NaF) 正电子发射断层扫描。参与者 (n=47) 与¹⁸F-NaF正电子发射断层扫描/计算机断层扫描在瓣膜植入后 1 个月（n=9, 19%）、2 年（n=22, 47%）或 5 年（16, 34%）。患者随后接受了连续超声心动图检查，以评估瓣膜血流动力学性能的变化（峰值主动脉速度的变化）和结构性瓣膜功能障碍的证据。与接受相同成像方案的生物瓣膜 SAVR (n=51) 的匹配患者进行了比较。结果：在 TAVI 患者中，天然主动脉瓣在生物瓣膜周围显示出¹⁸ F-NaF 摄取，与TAVI 的时间 ( r =0.36, P =0.023)。¹⁸SAVR 组和 TAVI 组生物瓣叶中 F-NaF 的摄取相当（目标与背景比分别为 1.3 [1.2-1.7] 和 1.3 [1.2-1.5]；P = 0.27）。在超声心动图（分别为 6% 和 8%；P = 0.78）、计算机断层扫描（分别为 15% 和 14%；P = 0.87）和正电子发射断层扫描（分别为 15% 和 29%；P = 0.09）。基线¹⁸ F-NaF 摄取与 TAVI ( r =0.7, P <0.001) 和 SAVR ( r =0.7, P<0.001)。在多变量分析中，¹⁸ F-NaF 摄取是峰值速度进展的唯一预测因子​​（P <0.001）。结论：在 TAVI 患者中，天然主动脉瓣证明存在持续活动性疾病的证据。在各种成像方式中，TAVI 退化与生物假体 SAVR 的程度相似，表明中期耐久性相当。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT02304276。