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Objective: Transcatheter aortic valve replacement (TAVR), previously reserved for patients of intermediate to prohibitive surgical risk, has now been expanded to patients of any surgical risk with severe aortic stenosis. Bioprostheses are prone to structural valve degeneration (SVD), a progressive and multifactorial process that limits valve durability. As the population undergoing TAVR shifts toward a lower-risk and younger profile, long-term durability is a crucial determinant for patient outcomes. Our objective was to determine the incidence and risk factors of SVD at midterm follow-up in a veteran TAVR population.Methods: Patients undergoing TAVR at our federal facility were retrospectively evaluated for SVD and other endpoints with standardized consensus criteria. Multivariable Cox proportional hazards analysis was performed to evaluate risk factors for mortality and SVD.Results: From 2013 to 2020, 344 patients (median age, 78 years) underwent TAVR. Survival from all-cause mortality was 91.3% at 1 year, 75.1% at 3 years, and 61.7% at 5 years. Cumulative freedom from SVD was 98.2% at 1 year, 96.5% at 3 years, and 93.7% at 5 years. All 13 patients with SVD met hemodynamic criteria, and 1 required intervention. Median time to hemodynamic SVD was 1.04 years. Independent risk factors for SVD included age (hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.86 to 0.99) and valve size (HR = 0.19, 95% CI: 0.04 to 0.89).Conclusions: SVD was evident at a low but detectable rate at 5-year follow-up. Further understanding of TAVR biomechanics as well as continued longer-term follow-up will be essential for informing patient-specific risk of SVD.

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Objective:Since QRS duration and QT interval have been demonstrated to have independent prognostic value, we hypothesized that seperating depolarization (QRS duration) and repolarization (JT interval) into individual components would enhance the prognostic power of these ECG measurements.Methods:Participants include 19,695 veterans who had an initial ECG at the Palo Alto Veterans Affairs (VA) Health Care System between March 31, 1987, and December 20, 1999, and were followed for cardiovascular (CV) death. Linear regression analysis was used to evaluate how QT correction formulas were correlated with its components (QRS and JT interval) and heart rate. Cox proportional hazard regression analysis was performed to estimate the hazard ratio of the corrected QT interval, corrected JT interval and the QRS interval for risk prediction of cardiovascular death.Results:During median of 17.5 years of follow-up, 739 cardiovascular deaths occurred. Comparison of mean JT intervals among those with normal and abnormal ventricular rhythms showed that the latter group had significantly lower JTc intervals (312 msec vs 298 msec). JTc interval was inversely correlated with QRS interval. The QTc interval was mostly dependent on the JTc interval rather than the QRS segment. However, prolongation of both the JTc and QRS increase the risk of QTc prolongation with similar odds ratios. Among those with normal ventricular conduction rhythms, prolongation of the JTc (HR; 1.12(1.10-1.15)), QRS(HR;1.29(1.22-1.37)) and QTc(HR; 1.15(1.13-1.17)) increased the risk of CVD. Among those with ventricular conduction abnormalities, increases in JTc interval did not increase the risk of CVD (HR; 1.04(0.96-1.12)), however, increase in QRS and QT was associated with increased risk of CVDConclusion:Individuals with ventricular conduction abnormalities had significantly shorter JTc intervals compared with the general population. In that cohort, increases in JTc did not increase the risk of CVD, however, prolongation of QRS and QTc was associated with increased risk of CVD. Among individuals with normal ventricular rhythms, prolongation of all three intervals, the JTc, QRS and QTc, increase the risk of CVD.