Balloon-expandable valves offered early survival and conduction preservation advantages, while self-expanding valves provided superior hemodynamic performance, with comparable long-term mortality.
Meta-Analysis
Do balloon-expandable valves improve clinical and procedural outcomes compared to self-expanding valves in adults with severe aortic stenosis undergoing transfemoral TAVR?
In transfemoral TAVR, BEVs and SEVs offer comparable long-term safety and mortality, but differ in early survival, conduction preservation, and hemodynamics, emphasizing the need for individualized valve selection.
BACKGROUND: Balloon-expandable valves (BEVs) and self-expanding valves (SEVs) are the two primary platforms for transcatheter aortic valve replacement (TAVR), differing in design, deployment, and hemodynamic performance. Comparative evidence on their clinical and procedural outcomes remains limited and inconsistent. METHODS: A systematic review and meta-analysis were conducted, searching PubMed, Scopus, Web of Science, and Cochrane Library up to July 2025 for studies comparing BEVs and SEVs in adults with severe aortic stenosis undergoing transfemoral TAVR. Outcomes included all-cause mortality, cardiovascular mortality, stroke, permanent pacemaker implantation, hemodynamic parameters, device success, and safety endpoints. Dichotomous and continuous outcomes were pooled as risk ratios (RR) and mean differences (MD) with corresponding 95% confidence intervals (CI) using a random-effects model. RESULTS: ). Long-term mortality and safety outcomes, including major bleeding, vascular complications, and myocardial infarction, were comparable. CONCLUSION: BEVs offer early survival and conduction preservation advantages, while SEVs provide superior hemodynamic performance. These findings highlight the importance of individualized valve selection based on patient-specific factors. Further randomized trials with extended follow-up are needed to evaluate long-term durability and outcomes in diverse patient populations.
Hafez et al. (2026) conducted a meta-analysis in Severe aortic stenosis. Balloon-expandable valves vs. Self-expanding valves was evaluated on All-cause mortality, cardiovascular mortality, stroke, permanent pacemaker implantation, hemodynamic parameters, device success, and safety endpoints. Balloon-expandable valves offered early survival and conduction preservation advantages, while self-expanding valves provided superior hemodynamic performance, with comparable long-term mortality.