Balloon-expandable valves vs self-expanding valves for transcatheter aortic valve replacement in bicuspid aortic valve stenosis: a meta-analysis

Introduction Comparative data between balloon-expandable valves (BEVs) and self-expanding valves (SEVs) in the treatment of bicuspid aortic valve (BAV) stenosis is limited. Asymmetric calcification, elliptical annular geometry, and aortic root dilation may influence valve expansion and clinical outcomes following transcatheter aortic valve replacement (TAVR) in BAV. Purpose We conducted a meta-analysis to evaluate the clinical outcomes comparing BEVs with SEVs in patients undergoing TAVR for BAV stenosis. Methods PubMed, Scopus, and Cochrane were systematically searched for studies comparing BEV with SEV for TAVR in BAV stenosis from inception through February 2026. Outcomes of interest included procedural, 30-day, and 1-year mortality, annulus rupture, coronary obstruction, permanent pacemaker implantation (PPI), moderate or severe paravalvular leakage (PVL), and need for additional valve implantation. Random effects models were applied to generate risk ratios (RRs) with 95% confidence intervals (CIs). Results 22 observational studies with 5,466 patients (BEV: 2,918; 53%) were included. PPI (RR 0.67; 95%CI 0.57-0.78), PVL (RR 0.34; 95%CI 0.17-0.69), and need for additional valve implantation (RR 0.35; 95%CI 0.22-0.58) were lower with BEV compared with SEV. (Figure) However, annulus rupture was higher with BEV (RR 2.80; 95%CI 1.19-6.57) compared with SEV. (Figure) Other outcomes were comparable between BEV and SEV. Conclusion BEVs in TAVR for BAV stenosis showed a lower risk of PPI, PVL, and additional valve implantation, but a higher risk of annulus rupture compared with SEVs. Careful patient selection is crucial, and additional randomised trials are necessary to determine the optimal strategy.