Valve thrombosis or valve deterioration: what truly drives the prognosis?

A successful transcatheter aortic valve intervention (TAVI) procedure does not mark the endpoint but rather the beginning of a new prosthetic valve journey. The paradigm has shifted from procedural safety to mid- and long-term outcomes, particularly in comparison with conventional surgical aortic valve replacement. A key question remains unanswered: what drives meaningful long-term prognostic benefit after TAVI? Evidence to guide valve optimisation − including adequacy of valve expansion, antithrombotic regimen, imaging surveillance, and the optimal timepoint for reintervention − is urgently needed.

Contemporary TAVI technology consistently achieves low postprocedural gradients. Most patients remain asymptomatic, while surveillance imaging may begin to reveal subtle changes. Data from the Bern TAVI registry demonstrate that one in four patients developed haemodynamic valve deterioration (HVD) at ten years of follow-up, with valve-in-valve procedures carrying a fivefold higher rate.1 A larger single-centre study further reported that early HVD occurred in 6.2% of patients within one year and was independently associated with a higher rate of aortic valve reintervention at five years.2 The correlation between echocardiographic findings and adverse clinical outcomes, however, remains inconclusive. Standardised definitions...