Balloon-Expandable Versus Self-Expandable Transcatheter Aortic Valve Implantation Devices: A Contemporary Systematic Review

Abstract

Background/Objectives: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. Prosthesis selection is increasingly important because balloon-expandable valves (BEVs) and self-expandable valves (SEVs) differ in deployment, hemodynamics, and lifetime-management implications. This systematic review synthesized contemporary evidence comparing BEVs and SEVs, while platform-, generation-, and subgroup-specific studies provided contextual evidence. Methods: A PubMed-only systematic search was performed on 25 January 2026 for studies published between 1 January 2020 and 31 December 2025. Eligible human studies evaluated contemporary balloon or self-expandable systems. Randomized and observational studies, including single-arm cohorts, were included. Risk of bias was assessed using the revised Cochrane Risk of Bias tool (RoB 2) and the Methodological Index for Non-Randomized Studies (MINORS). Because of heterogeneity, findings were synthesized narratively without meta-analysis. Direct randomized and adjusted comparative evidence received greatest weight, whereas single-arm and within-platform studies were not interpreted as establishing comparative superiority. Results: Fifty studies met the eligibility criteria. No consistent mortality advantage was identified for either expansion mechanism. The most reproducible differences concerned hemodynamics, paravalvular regurgitation, and conduction outcomes. Supra-annular SEVs were more consistently associated with lower residual gradients and less prosthesis–patient mismatch, whereas BEVs showed lower paravalvular regurgitation or permanent pacemaker implantation in selected comparative settings. These signals varied by valve generation, implantation technique, anatomy, and study design. Evidence on coronary reaccess, durability, thrombosis, and reintervention was less extensive. Conclusions: Contemporary evidence does not support a universal BEV-versus-SEV hierarchy. Prosthesis selection should be individualized according to anatomy, conduction risk, hemodynamic priorities, and lifetime-management considerations. Comparative conclusions should remain generation-specific and distinguish direct comparative evidence from single-arm or anatomically selected cohorts. The review was not prospectively registered and received no external funding.