Current Generation Self-Expanding and Balloon-Expandable Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Analysis

BACKGROUND: Evolving transcatheter aortic valve replacement (TAVR) technology warrants updated comparisons of the most commonly used current generation self-expanding (SE) versus balloon-expandable (BE) transcatheter heart valves (THV). METHODS: This 9-center retrospective analysis stratified patients undergoing TAVR from 2021-2024 into SE-THV and BE-THV cohorts balanced via propensity score matching. Primary outcomes were all-cause and cardiovascular mortality, stroke, and permanent pacemaker (PPM) need. Secondary outcomes were paravalvular leak (PVL) and acute kidney injury. All outcomes were assessed perioperatively and at 30 and 400 days. Analyses were repeated within LVEF , aortic valve area, and center-level strata. RESULTS: The total cohort included 2,594 BE-THV and 1,058 SE-THV patients. Matching yielded 680 patients per cohort. After matching , SE-THV patients had higher risk for ischemic stroke (p<0.05) and PPM (p<0.05) during index hospitalization, with no difference in mortality. At follow-up, the SE-THV cohort had higher risk of mild (p<0.05) and moderate (p<0.05) paravalvular leak, stroke (p<0.05) and PPM (p<0.05). PPM after SE-THV was significantly lower in high-volume compared to low-volume centers. Kaplan-Meier survival did not differ. Among patients with LVEF ≥45%, SE-THV was associated with higher stroke risk (p<0.05); BE-THV patients with LVEF < 45% were associated with increased all-cause mortality. CONCLUSIONS: In this cohort, SE-THV correlated with higher rates of ischemic stroke, PPM need, and PVL during index hospitalization and increased mild and moderate PVL upon follow-up. Mortality did not differ during index hospitalization or at follow-up. The normal LVEF SE-THV cohort was associated with higher stroke risk compared to all other groups.