Outcomes of Transcatheter Aortic Valve Replacement Using Third-Generation Balloon-Expandable Versus Self-Expanding...

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Transcatheter aortic valve replacement (TAVR) prosthesis selection is critical for patient outcomes.
• Third-generation valves offer advancements in TAVR technology.
• Comparing balloon-expandable valves (BEV) and self-expanding valves (SEV) is essential for clinical decision-making.

Purpose of the Study:

• To perform a meta-analysis comparing outcomes of third-generation BEV versus SEV in TAVR.
• To evaluate differences in mortality, clinical events, and hemodynamic performance.

Main Methods:

• Systematic search of electronic databases up to June 2023.
• Inclusion of 16 studies with 10,174 patients (5753 BEV, 4421 SEV).
• Random-effects models used to assess all-cause mortality and secondary clinical/hemodynamic endpoints.

Main Results:

• No significant difference in 1-year all-cause mortality between BEV and SEV.
• BEV associated with lower rates of TIA/stroke, permanent pacemaker implantation, and moderate paravalvular leak (PVL).
• BEV showed higher rates of moderate or severe patient-prosthesis mismatch, higher mean gradient, and smaller effective orifice area.

Conclusions:

• Third-generation BEV and SEV demonstrate comparable mortality in TAVR.
• BEV offers advantages in reducing stroke, pacemaker implantation, and PVL.
• Further large-scale randomized trials are needed to assess long-term outcomes with the latest TAVR valve generations.