Aortic stenosis (AS) is the most prevalent valvular heart disease in high-income countries. TAVI has expanded from high-surgical-risk to low-risk and younger populations, making long-term bioprosthetic valve durability a central clinical consideration.

Structural valve deterioration (SVD) is the principal factor limiting bioprosthetic valve longevity after TAVI. A 2024 state-of-the-art review shows bioprosthetic valve failure below 5% at midterm (5–8 year) follow-up, comparing favorably to surgical aortic valve replacement. Ten-year randomized trial data suggest comparable TAVI versus SAVR durability, though survivorship bias constrains interpretation. Non-structural dysfunction, including prosthesis-patient mismatch, paravalvular regurgitation, valve thrombosis, and endocarditis, also contributes to valve failure. Post-procedural high-sensitivity troponin-T modeling in a multicenter cohort of 5,158 TAVI patients identified a dynamic early risk trajectory, outperforming fixed-cutoff definitions for 1-year mortality prediction.

Interventional cardiologists, cardiac surgeons, structural heart specialists, and Heart Team members will benefit from peer discussion of TAVI durability evidence, lifetime management strategies, SVD monitoring, and post-procedural risk stratification.

How does evidence on structural valve deterioration and 10-year TAVI durability influence your Heart Team discussions regarding TAVI versus SAVR in younger or low-surgical-risk patients with severe aortic stenosis?

What post-procedural surveillance protocols do you apply following TAVI, and how do you incorporate biomarker trajectories and echocardiographic follow-up into long-term valve monitoring?