Conclusion
Concluding the data given by this study and the presently available
literature, it seems to be evident that the initial clinical and
hemodynamic results are satisfying. The procedure is safe and effective.
Nonetheless, small true-ID’s equal or less 21mm are associated with
inferior hemodynamic outcomes. Due to the high overall-mortality in the
study population, a potential significant difference in long-term
survival potentially is concealed. In contrast to only one available
long-term-study on hemodynamic outcomes, the present study showed
steadily increasing pressure gradients over time, independently from
true-ID of the surgical valve or type of transcatheter prosthesis. After
3-years more than 70% of the patients did not meet the VARC-2-device
success criteria anymore. This finding is a matter of concern and needs
to be evaluated by further studies prior bringing VIV-TAVR into younger
and lower risk patients.