Long-Term Durability of Transcatheter Valves

Highlights

• Echocardiographic definitions of structural valve deterioration must include a change in leaflet morphology accompanied by a deterioration in hemodynamic function.

• An absolute mean gradient equal or >20 mm Hg can occur as a result of patient-prosthesis mismatch and cannot, alone, be used to define structural valve deterioration.

• Studies of replacement valve durability should use core laboratories and report the percentage of patients having serial echocardiography.

Abstract

As transcatheter valves are offered to progressively lower-risk patients, it is increasingly important to have accurate data about durability. Structural valve deterioration (SVD) implies an adverse change in the morphology of the leaflets and function of the valve compared with the state at implantation. However, a recent European statement allows SVD to be defined solely by a threshold mean gradient ≥20 mm Hg. Absolute mean gradients above this threshold may be observed immediately after implantation and represent patient–prosthesis mismatch and not SVD. This paper describes a definition of SVD more in keeping with routine clinical practice, incorporating a change in leaflet morphology and an increase in the grade of transvalvar regurgitation or an increase in gradient from the post-implantation study.