Balloon-Expandable Vs Self-Expanding Valves for Transcatheter Aortic Valve Implantation in Internally Stented Surgical Valves

Background Internally stented (IS) surgical valves, such as Mitroflow and Trifecta, are known to carry an elevated risk for coronary artery obstruction during Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) procedures. The data of comparison between balloon-expandable valves (BEV) and supra-annular self-expanding valves (SEV) for ViV-TAVI within the IS remains unclear. This study aimed to evaluate clinical and hemodynamic outcomes of BEV and SEV for TAVI within the IS. Methods Between January 2016 and February 2024, propensity score matching (PSM) was performed between BEV and SEV groups in patients undergoing ViV-TAVI within IS. The data of baseline characteristics, hemodynamic parameters, and clinical outcomes were retrospectively collected. Primary endpoints were 30-day and 2-year clinical outcomes, including all-cause death, hospitalization for heart failure, and coronary obstruction. Results In total, 113 patients were included in this analysis. Sixty-three patients (55.8%) underwent BEV, and 50 patients (44.2%) underwent SEV. Overall, 37 pairs were identified after PSM. At day 30, the clinical and hemodynamic outcomes were similar between the groups. Patients with SEV had better post-procedural mean gradient at 1-year compared with those with BEV (11.7±4.3 mmHg vs 22.7±8.4 mmHg; p<0.001). No significant difference was observed between SEV and BEV in the cumulative 2-year composite endpoint (log-rank p=0.489). Conclusions In patients who underwent ViV within IS, the early- and mid-term clinical outcomes were comparable between BEV and SEV. However, SEV was associated with superior hemodynamics at 1-year follow-up than BEV.