Key result
Balloon-expandable and self-expanding transcatheter aortic valves showed similar mid-term outcomes, with BE valves having less paravalvular regurgitation and pacemaker implantation.
Why the study?
Multiple balloon-expandable and self-expanding transcatheter aortic valves are available in clinical practice, each with potential advantages and disadvantages that must be considered.
Do balloon-expandable transcatheter aortic valves compared to self-expanding valves offer different clinical and hemodynamic outcomes in patients undergoing TAVR?
Do balloon-expandable transcatheter aortic valves compared to self-expanding valves offer different clinical and hemodynamic outcomes in patients undergoing TAVR?
Balloon-expandable and self-expanding TAVs have similar mid-term outcomes but differ in specific procedural and hemodynamic advantages, requiring tailored device selection based on patient anatomy and future intervention needs.
INTRODUCTION: Currently, several balloon-expandable (BE) and self-expanding (SE) transcatheter aortic valves (TAVs) are available in clinical practice. Each of them has potential advantages and disadvantages that must be taken into account. AREAS COVERED: New-generation BE and SE TAVs showed similar mid-term outcomes after transfemoral transcatheter aortic valve replacement (TAVR) and better results compared to early-generation devices.BE TAVs showed better results in terms of residual paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI), whereas SE TAVs had better performance in terms of residual transvalvular gradients, larger effective orifice areas (EOAs) and therefore lower rates of prosthesis-patients mismatch (PPM). On one hand, supra-annular CoreValve/Evolut SE TAVs seems to have better results compared to SAPIEN XT/3 BE valves when used in the setting of valve-in-valve procedures in small bioprostheses. On the other hand, the need of ensuring an easy coronary re-access after TAVR especially in younger patients seems to favor the large cell design of SAPIEN 3/ULTRA BE valves. Finally, first long-term durability reports seem to suggest lower rates of structural valve dysfunction (SVD) with supra-annular SE TAVs. EXPERT OPINION: Although currently available TAVs showed similar mid-term outcomes, the expansion of TAVR indications toward lower risk, younger patients imposes attention to long-term durability, and to the need of obtaining optimized EOAs and an easy coronary re-access for future percutaneous interventions.
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Costa et al. (2020) conducted a review in Transcatheter aortic valve replacement. Balloon-expandable (BE) transcatheter aortic valves vs. Self-expanding (SE) transcatheter aortic valves was evaluated on Mid-term outcomes. Balloon-expandable and self-expanding transcatheter aortic valves showed similar mid-term outcomes, with BE valves having less paravalvular regurgitation and pacemaker implantation.
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