Urgent TAVI with self-expanding versus balloon-expandable valves in patients with acute heart failure showed no significant difference in long-term mortality (HR 0.73; 95% CI 0.51-1.04).
Observational (n=587)
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 undergoing urgent TAVI for severe aortic stenosis presenting in acute heart failure, there is no significant difference in long-term survival between self-expanding and balloon-expandable valves.
Effect estimate: HR 0.73 (95% CI 0.51-1.04)
p-value: p=0.017
BACKGROUND Transcatheter Aortic Valve Implantation (TAVI) is an effective therapy in patients with severe aortic stenosis presenting in acute heart failure, though whether self-expanding (SEV) or balloon-expandable valves (BEV) should be used in such cases is unknown. The aim of study is to compare SEV with BEV in such patients. METHODS Consecutive patients undergoing urgent TAVI with either SEV or BEV at two tertiary hospitals between 2012 and 2024 were studied. The primary endpoint was long-term survival over a median follow-up of 60 months. Secondary endpoints included technical and device success, in-hospital mortality, periprocedural complications, and echocardiographic valve performance. A subgroup analysis evaluated more contemporary devices (after 1/1/2017). RESULTS A total of 587 patients underwent urgent TAVI SEV (N = 321) and BEV (N = 266). BEV patients had higher rates of prior myocardial infarction and stroke. BEV achieved higher technical and device success, lower in-hospital mortality, and less post-TAVI aortic regurgitation. Although Kaplan-Meier analysis suggested better survival with BEV (log-rank p = 0.017) adjusted Cox regression revealed no significant mortality difference (HR 0.73, 95%CI 0.51-1.04). Outcomes were also comparable in the contemporary device subgroup (n = 299). CONCLUSIONS 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. No statistically significant difference in long-term survival was observed between SEV and BEV, supporting individualized device selection based on anatomy and operator preference.
Apostolos et al. (Sat,) conducted a observational in severe aortic stenosis presenting in acute heart failure (n=587). Self-expanding valves (SEV) vs. Balloon-expandable valves (BEV) was evaluated on long-term survival (HR 0.73, 95% CI 0.51-1.04, p=0.017). Urgent TAVI with self-expanding versus balloon-expandable valves in patients with acute heart failure showed no significant difference in long-term mortality (HR 0.73; 95% CI 0.51-1.04).