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Updated: Jul 25, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Supra-Annular Self-Expanding Versus Balloon-Expandable Valves for Valve-in-Valve Transcatheter Aortic Valve
Danial Ahmad1, Michel Pompeu Sá1, Sarah Yousef1
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THVs) show similar survival in valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). SE THVs had lower gradients and less prosthesis-patient mismatch, suggesting design differences warrant further study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
- Valve-in-valve (ViV) TAVR is used for degenerated surgical aortic valves.
- Limited data exist comparing self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THVs) in ViV-TAVR.
Purpose of the Study:
- To compare clinical and echocardiographic outcomes of SE and BE THVs in ViV-TAVR.
- To evaluate survival and prosthesis-patient mismatch in patients undergoing ViV-TAVR with SE versus BE THVs.
Main Methods:
- Retrospective analysis of institutional data from 2013-2023.
- Inclusion of 315 patients who underwent ViV-TAVR.
- Propensity-score matching (1:1) to compare SE and BE THV groups, with Kaplan-Meier survival analysis.
Main Results:
- SE THVs were implanted in 73% of patients.
- At 30 days and 1 year, SE THVs showed lower mean aortic valve gradients compared to BE THVs.
- Severe prosthesis-patient mismatch was more frequent with BE THVs (16% vs 6.2%).
- 30-day and 1-year mortality were comparable between groups (2.7% and 7.5%, respectively).
- Survival and stroke incidence were similar up to 5 years.
Conclusions:
- Self-expanding and balloon-expandable THVs demonstrate comparable survival in ViV-TAVR.
- Higher residual gradients in BE THVs may be linked to valve design.
- Long-term evaluation is needed to assess potential structural valve degeneration differences.
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