Cardiac Valve Diseases and Treatments Peer reviewed

Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement

Antonin Trimaille, Pedro Cepas‐Guillén, Marina Ureña, Alberto Alperi and 29 more

Circulation Cardiovascular Interventions | Aug 24, 2026

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The findings support the implementation of tailored surveillance and preventive strategies to mitigate BVF-related risk and support the implementation of tailored surveillance and preventive strategies to mitigate BVF-related risk.

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BACKGROUND: Data on the long-term incidence and clinical impact of bioprosthetic valve failure (BVF) after transcatheter aortic valve replacement remain limited. This study aimed to assess the incidence, predictors, and clinical impact of BVF following transcatheter aortic valve replacement. METHODS: We analyzed data from an international, multicenter registry including consecutive patients undergoing transcatheter aortic valve replacement at 13 centers. The primary outcome was BVF according to Valve Academic Research Consortium-3 criteria. The cumulative incidence of BVF was estimated using a competing-risk approach. The association between BVF and clinical outcomes was assessed using competing-risk models with BVF as a time-dependent covariate. RESULTS: Among 7501 patients, BVF occurred in 380 (5.1%) patients over a median follow-up of 4 (interquartile range, 2–5) years. The cumulative incidence of BVF increased over time, reaching 1.4% at 1 year, 4.6% at 5 years, and 8.3% at 10 years. Independent predictors of BVF included younger age, smoking, balloon-expandable valve, prosthesis size <26 mm, valve-in-valve procedure, mean gradient at discharge ≥15 mm Hg, moderate or severe aortic regurgitation at discharge, and early hemodynamic valve deterioration. BVF was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 1.72 [95% CI, 1.47–2.01]; P <0.001), cardiovascular mortality (adjusted hazard ratio, 3.23 [95% CI, 2.73–3.82]; P <0.001), stroke (adjusted hazard ratio, 2.08 [95% CI, 1.02–4.23]; P =0.043), and heart failure hospitalization (adjusted hazard ratio, 1.43 [95% CI, 1.03–1.98]; P =0.032). Consistent findings were observed in different sensitivity analyses. CONCLUSIONS: BVF is a clinically relevant event associated with adverse long-term outcomes. These findings support the implementation of tailored surveillance and preventive strategies to mitigate BVF-related risk.

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Authors

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Antonin Trimaille

first | Lung Institute | ORCID 0000-0001-9279-4220

Pedro Cepas‐Guillén

middle | Lung Institute | ORCID 0000-0001-8814-7039

Marina Ureña

middle | Lyon 1 Université | ORCID 0000-0002-4150-290X

Alberto Alperi

middle | Hospital Universitario Central de Asturias | ORCID 0000-0002-9939-8949

Gabriela Veiga Fernández

middle | Instituto de Investigación Marqués de Valdecilla | ORCID 0000-0002-5512-3820

Luis Nombela‐Franco

middle | Hospital Clínico San Carlos | ORCID 0000-0003-3438-8907

Victòria Vilalta

middle | Hospital Universitari Germans Trias i Pujol | ORCID 0000-0003-1767-5963

María Del Trigo

middle | Hospital Universitario Puerta de Hierro Majadahonda | ORCID 0000-0001-8276-7325

Antonio J. Muñoz-García

middle | Hospital Clínico Universitario Virgen de la Victoria

Giovanni Esposito

middle | Federico II University Hospital | ORCID 0000-0003-0565-7127

Vincent Auffret

middle | Université Rennes 2 | ORCID 0000-0003-0535-2120

David del Val

middle | Hospital Universitario de La Princesa | ORCID 0000-0001-7784-5501

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BibTeX

@article{Trimaille2026Bioprosthetic,
  title = {Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement},
  author = {Antonin Trimaille and Pedro Cepas‐Guillén and Marina Ureña and Alberto Alperi and Gabriela Veiga Fernández and Luis Nombela‐Franco and Victòria Vilalta and María Del Trigo and Antonio J. Muñoz-García and Giovanni Esposito and Vincent Auffret and David del Val and Vicenç Serra and Jorge Nuche and Lluís Asmarats and Ander Regueiro and Adrien Carmona and Quentin Fischer and Pablo Avanzas and Víctor Fradejas-Sastre and Ivan Sanchez and Michele Trichilo and J. Domínguez and Anna Franzone and Maxime Nolf and Fernándo Alfonso and Pedro Diaz Pockels and Rocío Rodríguez-Santolino and Dabit Arzamendi and Eduardo Flores‐Umanzor and Olivier Morel and Marisa Avvedimento and Josep Rodés‐Cabau},
  journal = {Circulation Cardiovascular Interventions},
  year = {2026},
  doi = {10.1161/circinterventions.126.016892},
  url = {https://doi.org/10.1161/circinterventions.126.016892}
}

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