Self-expanding valves showed no significant difference in long-term mortality compared to balloon-expandable valves in urgent TAVI (HR 0.96; 95% CI 0.54-1.72; p=0.894).
Cohort (n=299)
Yes
Does the use of self-expanding valves compared to balloon-expandable valves improve long-term survival in patients with severe aortic stenosis presenting in acute heart failure undergoing urgent TAVI?
In patients presenting with acute heart failure undergoing urgent TAVI, the choice between self-expanding and balloon-expandable valves does not significantly affect long-term survival.
Effect estimate: HR 0.96 (95% CI 0.54-1.72)
p-value: p=0.894
Abstract Background Transcatheter Aortic Valve Implantation (TAVI) is an established treatment in patients with severe aortic stenosis presenting in acute heart failure. Nevertheless, whether self-expanding (SEV) or balloon-expandable valves (BEV) should be preferred in such cases remains under investigation. The aim of study is to compare contemporary SEV with BEV in patients undergoing urgent TAVI. Methods Consecutive patients undergoing urgent TAVI with either SEV or BEV at two tertiary hospitals between 2017 and 2024 were studied. The primary endpoint was long-term survival. Secondary endpoints included technical and device success, in-hospital mortality, periprocedural complications, and echocardiographic valve performance. Results A total of 299 patients underwent urgent TAVI SEV (N=144) and BEV (N=155). Baseline characteristics showed a higher proportion of females and lower creatinine levels in the SEV group. Patients treated with BEV had higher rates of previous MI and ischemic stroke/TIA. Technical and device success was comparable between contemporary SEV and BEV (95.9% vs. 96.5%, p=0.812 and 87.9% vs. 90.7%, p=0.812, respectively). No significant differences were observed in in-hospital mortality (0.7% vs. 2.9%, p=0.370), valve malpositioning (5.8% vs. 4.9%, p=0.717), and valve migration (0.6% vs. 2.8%, p=0.200) between SEV and BEV. Patients treated with contemporary SEV had significantly higher aortic valve mean gradient (9 6 -13 vs. 8 10 – 14 mmHg, p=0.031), significantly lower peak velocity (2.0 1.8 – 2.4 vs. 2.2 2.0 – 2.5 m/s, p=0.003) and higher AR rates (mild: 23.1% vs. 50.4%, moderate: 0.7% vs. 4.3%, severe: 0% vs. 0.7%, p0.001). Kaplan-Meier survival analysis showed no significant difference in long-term survival between SEV and BEV (log-rank p=0.994). The estimated mean survival was 65.0 months (95% CI: 58.1–71.8) for SEV and 94.4 months (95% CI: 77.7–111.1) for BEV. In multivariable Cox regression adjusted for sex, previous MI, creatinine levels, prior ischemic stroke/TIA, aortic valve mean gradient, and pre-TAVI mitral regurgitation, THV design was not associated with mortality (HR: 0.96, 95% CI: 0.54–1.72, p=0.894). Severe pre-TAVI mitral regurgitation was an independent predictor of mortality (HR: 5.14, 95% CI: 1.69–15.64, p=0.004). Conclusion To the best of our knowledge, this is the first analysis comparing long-term outcomes in patients presenting in acute heart failure undergoing urgent TAVI between SEV and BEV. Valve choice in urgent TAVI appears not to affect long-term survival, supporting individualized device selection based on anatomy and operator preference.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
Apostolos et al. (Sun,) conducted a cohort in severe aortic stenosis presenting in acute heart failure (n=299). Self-expanding valves (SEV) vs. Balloon-expandable valves (BEV) was evaluated on long-term survival (HR 0.96, 95% CI 0.54-1.72, p=0.894). Self-expanding valves showed no significant difference in long-term mortality compared to balloon-expandable valves in urgent TAVI (HR 0.96; 95% CI 0.54-1.72; p=0.894).