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Over the past few years, transcatheter aortic valve implantation (TAVI) imposed itself as the first-choice therapy for symptomatic aortic stenosis (AS) in elderly patients at surgical risk. There have been continuous technological advancements in the latest iterations of TAVI devices and implantation techniques, which have bolstered their adoption. Moreover, the favorable outcomes coming out from clinical trials represent an indisputable point of strength for TAVI. As indications for transcatheter therapies now include a low surgical risk and younger individuals, new challenges are emerging. In this context, the matter of prosthesis durability is noteworthy. Initial evidence is beginning to emerge from the studies in the field, but they are still limited and compromised by multiple biases. Additionally, the physiopathological mechanisms behind the valve's deterioration are nowadays somewhat clearer and classified. So, who outlasts who—the valve or the patient? This review aims to explore the available evidence surrounding this intriguing question, examining the various factors affecting prosthesis durability and discussing its potential implications for clinical management and current interventional practice. [ABSTRACT FROM AUTHOR]

Encouraged by randomized controlled trials demonstrating non-inferiority of transfemoral transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) across all surgical risk categories, there has been a dramatic increase in the use of TAVI in a younger patient cohort with severe aortic stenosis, endorsed by both European and American Cardiac Societies. However, the standard use of TAVI in younger, less co-morbid patients with a longer life expectancy can only be supported if there is sound data demonstrating long-term durability of transcatheter aortic valves (TAVs). In this article, we have reviewed available randomized and observational registry clinical data pertaining to TAV long-term durability, placing emphasis on trials and registries using the new standardized definitions of bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF). Despite inherent difficulties in interpreting the available data, the determination reached is that the risk of structural valve deterioration (SVD) is potentially lower after TAVI than SAVR at 5 to 10 years, and that the two treatment modalities have a similar risk of BVF. This supports the adoption of TAVI in younger patients evident in current practice. However, the routine use of TAVI in younger patients with bicuspid aortic valve stenosis should be cautioned due to insufficient long-term TAV durability data in this particular patient population. Finally, we highlight the importance of future research into the unique potential mechanisms that can potentially contribute to TAV degeneration.

The Inspiris Resilia tissue valve was recently introduced into clinical practice. This review summarizes the pre-clinical and clinical studies leading to this new bioprosthesis. The novel Resilia tissue was tested extensively in a large animal model. The clinical use of the tissue started in 2011 with the European Feasibility study, followed by a North-American multi-center study. Since 2017, the Inspiris Resilia valve has been in full commercial use. Further prospective evaluations and registries are ongoing. The Inspiris Resilia valve was clinically introduced after pre-clinical tests revealed superiority compared to contemporary therapy such as the Perimount valve. Prospective long-term follow-up studies on Resilia are ongoing since 2011 and reveal no major complications. Full 5-year data show no signs of early degeneration, but longer follow-up is certainly still needed. Several prospective registries are actively monitoring the outcome with the Inspiris Resilia valve now. The novel tissue, designed to mitigate calcification and increase durability, together with the expandable stent, facilitating potential future valve-in-valve (ViV) procedures, are the cutting-edge aspects. Clinical use in younger patients is currently ongoing: their follow-up and outcome will determine the added value of this valve. [ABSTRACT FROM AUTHOR]

Encouraged by randomized controlled trials demonstrating non-inferiority of transfemoral transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) across all surgical risk categories, there has been a dramatic increase in the use of TAVI in a younger patient cohort with severe aortic stenosis, endorsed by both European and American Cardiac Societies. However, the standard use of TAVI in younger, less co-morbid patients with a longer life expectancy can only be supported if there is sound data demonstrating long-term durability of transcatheter aortic valves (TAVs). In this article, we have reviewed available randomized and observational registry clinical data pertaining to TAV long-term durability, placing emphasis on trials and registries using the new standardized definitions of bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF). Despite inherent difficulties in interpreting the available data, the determination reached is that the risk of structural valve deterioration (SVD) is potentially lower after TAVI than SAVR at 5 to 10 years, and that the two treatment modalities have a similar risk of BVF. This supports the adoption of TAVI in younger patients evident in current practice. However, the routine use of TAVI in younger patients with bicuspid aortic valve stenosis should be cautioned due to insufficient long-term TAV durability data in this particular patient population. Finally, we highlight the importance of future research into the unique potential mechanisms that can potentially contribute to TAV degeneration., Competing Interests: GB, LS and ODB received institutional research grants and consulting fees from Abbott, Boston Scientific, and Medtronic. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Montarello, Willemen, Tirado-Conte, Travieso, Bieliauskas, Sondergaard and De Backer.)

Background: We examined the influence of multiple valve-related parameters on the onset and incidence of valve degeneration in aortic bioprostheses through detailed echocardiographic follow-up. Methods: In 648 patients (mean age, 73.8 ± 4.9 years) receiving an aortic valve bioprosthesis, long-term clinical (mean, 7.5 ± 3.2 years) and echocardiographic (mean, 6.5 ± 3.4 years) follow-up were performed. The occurrence of signs of structural valve degeneration (stenosis type and regurgitation type) was studied through multivariate analysis, including tissue origin, design and label size of the prosthesis, effective orifice area index (EOAi), patient-prosthesis mismatch (PPM; EOAi <0.85 cm2/m2), and antimineralization treatment. Results: Structural valve degeneration (SVD) was diagnosed in 12.6% of patients. In 7.6%, it was of the stenosis type (S-SVD); in 5%, it was the regurgitation type (R-SVD). The absence of antimineralization treatment is an independent predictor of SVD, S-SVD, and R-SVD. Patient-prosthesis mismatch is an independent predictor of SVD and S-SVD, but not of R-SVD. Patients receiving a nontreated valve show a freedom of SVD at 10 years follow-up of 70.1 ± 4.3% versus 90.9 ± 3.6% in patients receiving a treated valve (P < .0001). Patients having PPM and receiving a nontreated valve show a freedom of SVD at 10 years of follow-up of only 59.8 ± 7.0% versus 88.7 ± 3.6% in patients also having PPM but receiving a treated valve (P < .0001). In patients not having PPM, the corresponding values were 78.0 ± 4.3% and 92.7 ± 3.4% for nontreated versus treated valves respectively (P = .01). Conclusions: Antimineralization treatment of bioprosthetic heart valves is effective and reduces the incidence of SVD significantly. Because valve type and size are determined at the moment of implantation, the surgeon carries an important responsibility in protecting the patient from valve degeneration. [Copyright &y& Elsevier]