Balloon-Expanding Transcatheter Aortic Valve Replacement: A Single-Center Experience From the Inception of Transcatheter Aortic Valve Replacement

Background Transcatheter aortic valve replacement (TAVR) has transformed the management of severe aortic stenosis, with expanding indications and progressive device refinements. Long-term outcomes with balloon-expandable valves across device generations remain incompletely characterized. Methods We analyzed 4,137 patients who underwent balloon-expandable TAVR at a high-volume tertiary center from 2006 to 2022. Patients were stratified by device generation (SAPIEN 9000TFX, SAPIEN XT, and SAPIEN 3). Procedural outcomes, survival, echocardiographic follow-up, and reintervention rates were assessed. Cox regression and competing-risk analyses were performed to evaluate associations with mortality, stroke, and myocardial infarction. Results The mean age of the cohort was 79 ± 9.6 years, and 60.5% were male. Transfemoral access increased significantly with newer devices (90% with S3 vs. 74% with SXT and 41% with S9000TFX). Periprocedural complications declined across generations, with the S3 valve demonstrating the lowest rates of in-hospital mortality (0.3%), tamponade (0.1%), stroke (0.5%), and acute kidney injury (0.2%). During follow-up, all-cause mortality was significantly higher with S9000TFX compared with S3 (HR 1.43, 95% CI 1.25–1.64; p < 0.001). Long-term echocardiography demonstrated stable aortic valve gradients (<20 mmHg) and minimal PVL, especially in the S3 group. Only 10 patients required TAV-in-TAV intervention, with a median interval of ∼6 years, most of whom underwent repeat implantation of a similar-sized S3 valve. Conclusions In this large single-center experience with balloon-expandable TAVR, the contemporary era of newer-generation devices was associated with lower procedural complication rates, improved survival, and stable valve hemodynamics during follow-up among patients with available imaging. These findings underscore the rapid maturation of TAVR as a therapeutic option complementing surgical treatment in expanding treatment options for a wider spectrum of patients. Improved long-term survival has enabled a more robust assessment of valve durability, and TAV-in-TAV remains a viable treatment strategy for structural valve degeneration.