Novel clinical, procedural, and imaging predictors of long-term durability after transcatheter aortic valve replacement
O Ayyad, H Abu Khadija, J Alkrinawi, A Abdullah, D Najajra, A Mahamid, K Ibraheem, O Hamdan, M Masu'd, N Abu Hamdeh, D Elbirt, T Shalmon, R Cohen, M AlneesAbstract
Background
With the expansion of transcatheter aortic valve replacement (TAVR) to younger and lower-risk patients, long-term bioprosthetic valve durability has become a major clinical concern. While some procedural and anatomical contributors to valve deterioration have been explored, the overall landscape of durability predictors—including host-related mechanisms—remains incompletely understood, and the role of systemic inflammation remains largely unclear
Objectives
To investigate whether baseline systemic inflammation, early post-procedural valve hemodynamics, and anatomical characteristics are independently associated with long-term hemodynamic valve deterioration (HVD) after TAVR.
Methods
We performed a retrospective cohort study including 755 patients who underwent TAVR between 2015 and 2025 with echocardiographic follow-up for up to 10 years. HVD was defined according to VARC-3 criteria. Baseline systemic inflammation index (SII) was calculated from pre-procedural blood counts. Associations with HVD were evaluated using multivariable Cox proportional hazards models and a time-dependent matched (risk-set) analysis.
Results
During follow-up, 102 patients (13.5%) developed HVD. Patients with HVD had significantly higher baseline SII and higher early post-TAVR mean transprosthetic gradients. In multivariable analysis, SII (hazard ratio [HR] 1.58 per 10³ increase; 95% confidence interval [CI] 1.44–1.73), post-TAVR mean gradient (HR 1.46 per 5 mmHg; 95% CI 1.35–1.57), diabetes mellitus, female sex, and left ventricular outflow tract calcification were independently associated with HVD. In time-dependent matched analyses, elevated SII (HR 3.75; 95% CI 1.91–7.37) and higher post-TAVR mean gradient (HR 3.23; 95% CI 1.54–6.77) remained strong predictors of valve deterioration.
Conclusions
Baseline systemic inflammation and early post-procedural valve hemodynamics are independently associated with long-term hemodynamic valve deterioration after TAVR. Incorporating inflammatory biomarkers may improve risk stratification and surveillance strategies in contemporary TAVR practice.Geographical abstractFor image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.