One‐Year Clinical and Hemodynamic Outcomes in Latest Generation Balloon‐Expandable and Self‐Expandable Transcatheter Heart Valves

Background One‐year clinical and hemodynamic outcomes after transcatheter aortic valve replacement (TAVR) using the latest generation balloon‐expandable valve (BEV) and self‐expandable valve (SEV) is not well understood. This study is aimed to compare 1‐year morality and hemodynamics between the latest generation BEV and SEV after TAVR. Methods We retrospectively analyzed 1393 patients undergoing TAVR using BEV (63.7%) (SAPIEN3 Ultra RESILIA) and SEV (36.3%) (Evolut FX). The incidence of all‐cause mortality and bioprosthetic valve dysfunction (BVD) over 1‐year were compared between BEV and SEV in both overall and propensity score (PS) matched cohort. Results During 1‐year follow‐up, the incidence of all‐cause mortality was comparable between BEV and SEV in the overall (10.8% vs. 8.0%, log‐rank p = 0.30) and PS matched cohort (11.0% vs. 8.9%, log‐rank p = 0.40). The incidence of BVD through 1‐year was also comparable between BEV and SEV in the overall (6.2% vs. 6.9%, p = 0.59) and PS matched cohort (6.7% vs. 8.2%, p = 0.55). Of BVD component, post‐procedural mean pressure gradient more than 20mmH was higher in BEV, while para‐valvular leakage more than moderate was higher in SEV. There was non‐linear relationship between annulus size and BVD, in which TAVR with BEV had higher BVD in a small annulus, while SEV had higher BVD in a large annulus. Conclusions In TAVR using the latest generation valves, incidences of mortality and valve performance during 1‐year were comparable between BEV and SEV. Whereas, the impact of annulus size on the difference of valve hemodynamics between BEV and SEV is still observed.