Key result
Balloon-expandable valves show no long-term survival benefit over self-expanding valves in LV systolic dysfunction.
Why the study?
Do balloon-expandable valves compared to self-expanding valves improve long-term survival in patients with severe aortic stenosis and left ventricular systolic dysfunction undergoing TAVR?
Cohort (n=246)
No
Do balloon-expandable valves compared to self-expanding valves improve long-term survival in patients with severe aortic stenosis and left ventricular systolic dysfunction undergoing TAVR?
Absolute Event Rate: 50% vs 36%
p-value: p=0.92
In patients with severe aortic stenosis and left ventricular systolic dysfunction undergoing TAVR, balloon-expandable and self-expanding valves provide comparable long-term survival despite differences in post-procedural gradients.
OBJECTIVE: Patients with severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD) represent a particularly fragile subgroup undergoing transcatheter aortic valve replacement (TAVR). Comparative outcome data for balloon-expandable valves (BEV) and self-expanding valves (SEV) in this population remain scarce. METHOD: This retrospective single-center study evaluated 246 consecutive subjects with left ventricular ejection fraction (LVEF) < 50% who underwent transfemoral TAVR between January 2015 and June 2025. Clinical, echocardiographic, and procedural characteristics were compared between BEV (n = 96) and SEV (n = 150) recipients. Long-term all-cause mortality served as the primary endpoint. RESULTS: Individuals treated with BEV were older (78.8 +- 7.9 vs. 75.7 +- 9.8 years; P = 0.019) and demonstrated higher EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) values (24.9 +- 6.2% vs. 22.2 +- 15.8%; P = 0.01). Periprocedural and in-hospital clinical outcomes, including mortality, vascular complications, and pacemaker requirement, were comparable between groups. SEV implantation yielded lower post-procedural transvalvular gradients (mean 7.8 +- 4.0 mmHg vs. 9.6 +- 4.1 mmHg; P = 0.001). Although crude mortality was observed more frequently among BEV patients (50.0% vs. 36.0%; P = 0.041), Kaplan-Meier survival curves showed no survival difference (log-rank P = 0.92). In multivariable Cox regression, predictors of long-term mortality included older age (hazard ratio [HR] 1.05; P = 0.007), chronic obstructive pulmonary disease (COPD) (HR: 2.64; P < 0.001), coronary artery disease (HR: 2.08; P = 0.018), lower serum albumin (HR: 0.63; P = 0.011), and lower hemoglobin (HR: 0.84; P = 0.023); valve type was not predictive. CONCLUSION: In patients with LVSD undergoing TAVR, BEV and SEV provided comparable procedural and long-term outcomes. Although SEV yielded lower postoperative gradients, valve type did not affect survival. Future studies with larger samples and higher use of new-generation devices are warranted to refine valve selection in this high-risk group.
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Keskin et al. (2026) conducted a cohort in Severe aortic stenosis with left ventricular systolic dysfunction (n=246). Balloon-expandable valves (BEV) vs. Self-expanding valves (SEV) was evaluated on Long-term all-cause mortality (p=0.92). In patients with left ventricular systolic dysfunction undergoing TAVR, balloon-expandable and self-expanding valves provided comparable long-term survival (log-rank P = 0.92).
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