Key result
Self-expandable (n=146) and balloon-expandable (n=189) transcatheter heart valves showed no difference in the primary composite endpoint in patients with severe aortic stenosis and LVEF ≤40%.
Why the study?
Head-to-head comparisons between balloon-expandable and self-expandable transcatheter heart valves remain limited in patients with severe aortic stenosis and left ventricular systolic dysfunction.
Does self-expandable THV compared to balloon-expandable THV improve outcomes in patients with severe aortic stenosis and LVEF ≤40%?
Observational (n=335)
Yes
Does self-expandable THV compared to balloon-expandable THV improve outcomes in patients with severe aortic stenosis and LVEF ≤40%?
In patients with severe aortic stenosis and LVEF ≤40%, clinical outcomes and quality of life are similar up to 1 year regardless of whether a self-expandable or balloon-expandable transcatheter heart valve is used.
No difference in composite outcomes between valve types; leaves open optimal selection in low-LVEF aortic stenosis.
OBJECTIVE: The aim of this study was to compare outcomes of transcatheter heart valve (THV) choice in patients with left ventricular (LV) systolic dysfunction. BACKGROUND: The management congestive heart failure with combined LV systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. Head-to-head comparisons among the balloon-expandable (BEV) and self-expandable (SEV) THV remain limited in this subgroup of patients. METHODS: In this retrospective study, we included patients with severe AS with LV systolic dysfunction (LVEF ≤40%) who underwent TAVR at four high volume centers. Two thousand and twenty-eight consecutive patients were analyzed, of which 335 patients met inclusion criteria. One hundred fourty-six patients (43%) received a SEV, and 189 patients (57%) received a BEV. RESULTS: Baseline characteristics were similar except for a higher proportion of females in the SEV group. The primary composite endpoint of in-hospital mortality, moderate or greater paravalvular (PVL), stroke, conversion to open surgery, aortic valve reintervention, and/or need for permanent pacemaker (PPM) was no different among THV choice. There was more PVL in the SEV group, but higher transaortic gradients in the BEV group. Clinical outcomes and quality of life measures were similar up to 1 year follow-up. CONCLUSION: The choice of THV in patients with severe AS and systolic dysfunction must be weighed on a case-by-case basis.
No takes yet. Share an insight, caveat, or question.
Mustafa et al. (2022) conducted an observational in Severe aortic stenosis with left ventricular systolic dysfunction (n=335). Self-expandable transcatheter heart valve (SEV) vs. Balloon-expandable transcatheter heart valve (BEV) was evaluated on Composite of in-hospital mortality, moderate or greater paravalvular leak (PVL), stroke, conversion to open surgery, aortic valve reintervention, and/or need for permanent pacemaker (PPM). Self-expandable (n=146) and balloon-expandable (n=189) transcatheter heart valves showed no difference in the primary composite endpoint in patients with severe aortic stenosis and LVEF ≤40%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: