Key result
Balloon-expandable TAVR cuts pacemakers ~43% vs self-expanding valves in small annuli but increases prosthesis-patient mismatch.
Why the study?
Patients with a small aortic annulus undergoing TAVR face higher risks of prosthesis-patient mismatch and high valvular gradients, warranting a comparison of balloon-expandable versus self-expanding valves.
Do balloon-expandable valves compared to self-expanding valves improve hemodynamic and clinical outcomes in patients with severe aortic stenosis and a small aortic annulus undergoing TAVR?
Meta-Analysis (n=5,149)
Do balloon-expandable valves compared to self-expanding valves improve hemodynamic and clinical outcomes in patients with severe aortic stenosis and a small aortic annulus undergoing TAVR?
Mean Difference: -0.18 (95% CI -0.25–-0.1)
p-value: p=< 0.00001
In TAVR patients with a small aortic annulus, self-expanding valves offer superior hemodynamics and less prosthesis-patient mismatch, whereas balloon-expandable valves are associated with fewer permanent pacemakers and bleeding events.
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BEVs in small-annulus TAVR may cut pacemaker and bleeding risks versus SEVs but increase mismatch; supports individualized selection in trials and practice.
Background Balloon-expandable valve (BEV) and self-expanding valve (SEV) are used in transcatheter aortic valve replacement (TAVR). Patients with a small aortic annulus (SAA) make up to one-third of the cases and face higher risks of prosthesis-patient mismatch and high valvular gradients. Objectives This meta-analysis aimed to compare balloon-expandable and self-expanding valves used in TAVR in patients with a SAA, focusing on hemodynamic and clinical outcomes. Methods We systematically searched Cochrane Central, PubMed, and EMBASE for studies comparing balloon-expandable and self-expanding valves in patients with SAA undergoing TAVR. Random effects models were applied to generate odds ratios (ORs) and mean differences with 95% confidence interval (CI). Results Fifteen studies (two randomized controlled trials and 13 propensity-matched studies) with 5149 patients (48.4% balloon-expandable valves) were identified. BEVs were associated with a lower indexed effective orifice area (mean difference: ‐0.18, 95% CI: ‐0.25 to ‐0.10; P < 0.00001) and higher transvalvular mean pressure gradient (mean difference: 4.32, 95% CI: 3.39–5.24; P < 0.00001) and peak pressure gradients (mean difference: 4.87, 95% CI: 1.23–8.51; P = 0.009). Permanent pacemaker implantation (OR: 0.57, 95% CI: 0.44–0.73; P < 0.0001) and major bleeding (OR: 0.67, 95% CI: 0.47–0.96; P = 0.03) were lower in balloon-expandable valves. BEVs increased the odds of any prosthesis-patient mismatch (OR: 2.28, 95% CI: 1.61–3.22; P < 0.00001) and severe prosthesis-patient mismatch (OR: 3.16, 95% CI: 2.19–4.58; P < 0.00001). Conclusion In patients with SAA undergoing TAVR, SEVs offer superior hemodynamic performance, whereas BEVs are associated with fewer conduction disturbances and bleeding events. Both valve platforms yielded similar clinical outcomes, underscoring the need for individualized device selection.
Narciso et al. (2026) conducted a meta-analysis in severe aortic stenosis with small aortic annulus (n=5,149). Balloon-expandable valve vs. Self-expanding valve was evaluated on indexed effective orifice area (mean difference: -0.18, 95% CI -0.25 to -0.10, p=< 0.00001). Balloon-expandable valves reduced permanent pacemaker implantation (OR 0.57, 95% CI 0.44-0.73) but increased severe prosthesis-patient mismatch (OR 3.16, 95% CI 2.19-4.58) vs self-expanding valves.
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