Newer-generation balloon-expandable vs. self-expanding transcatheter aortic valves: a propensity score matched analysis.
Abstract
Aims
Balloon-expandable valve (BEV) and self-expanding valve (SEV) platforms have undergone significant technological advancements. This study aimed to compare postoperative outcomes in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve implantation (TAVI) using newer-generation BEV and SEV devices.
Methods
We retrospectively analyzed all patients who underwent TAVI for severe native AS at a single center between January 2018 and December 2023. Exclusion criteria included emergency procedures, active endocarditis, prior aortic valve interventions, bicuspid valves, primary aortic regurgitation, non-transfemoral access, concomitant coronary procedures, and use of retracted valves. Bioprosthetic valve dysfunction (BVD) was assessed according to modified Valve Academic Research Consortium 3 (VARC-3) definitions.
Results
Propensity score matching was used to create 354 well balanced pairs. Periprocedural outcomes, including mortality, were comparable between the matched BEV and SEV groups. However, echocardiographic evaluation at discharge revealed significantly higher mean transvalvular gradients (P < 0.001) and peak velocities (P < 0.001) in the BEV group. During follow-up, the SEV group showed a significantly lower incidence of BVD [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.45-0.91; P = 0.013], particularly regarding higher rates of severe prosthesis-patient mismatch (P = 0.001) and at least moderate structural valve deterioration (P = 0.006). No significant differences were observed in all-cause (HR: 1.18, 95% CI: 0.90-1.56, P = 0.235), or cardiac-related mortality (HR: 1.29, 95% CI: 0.91-1.83, P = 0.157).
Conclusion
Among patients treated with newer-generation transcatheter valves, SEV demonstrated more favorable hemodynamic performance compared with BEV. However, short- and mid-term mortality rates remained similar between the two groups. Longer-term follow-up of randomized trials is needed to confirm these findings.