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Transcatheter aortic valve implantation (TAVI) has expanded rapidly as a novel therapeutic strategy for patients with severe symptomatic aortic stenosis. This procedure is already well established in patients at intermediate or high risk for conventional surgical valve replacement and, with multiple studies currently evaluating TAVI in low-risk patients, use of this treatment is likely to continue to expand worldwide. While long-term outcome data are lacking, recent results from the Placement of Aortic Transcatheter Valves (PARTNER) trial indicated promising results at 5 years post-implantation, with TAVI valves demonstrating similar haemodynamics to surgical bioprosthetic valves and no evidence of structural valve deterioration on echocardiography.1 Despite these promising data, long-term TAVI durability and the mechanisms leading to structural valve degeneration are not fully understood. Improving our understanding of valve durability and the factors leading to TAVI valve deterioration is therefore paramount, particularly as we consider extending this technology to younger patient populations.
In their Heart manuscript, Del Trigo et al 2 investigate the relationship between the use of anticoagulation therapy and valve haemodynamic deterioration in over 2000 patients post-TAVI. In …