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Self-expanding versus balloon-expandable transcatheter heart valves in patients with excessive aortic valve cusp

Daijiro Tomii1, Bashir Alaour1, Dik Heg2

  • 1Department of Cardiology, Cardiovascular Center, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.

American Heart Journal
|September 20, 2025
PubMed

Insights

In transcatheter aortic valve replacement (TAVR) for patients with excessive aortic calcification, balloon-expandable valves (BEV) showed higher annular rupture risk but lower paravalvular regurgitation. Self-expanding valves (SEV) had higher pacemaker implantation rates, with similar 5-year mortality for both.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Excessive aortic calcification poses risks for transcatheter aortic valve replacement (TAVR) periprocedural complications.
  • Device performance differences in calcified aortic valves may impact long-term TAVR outcomes.

Purpose of the Study:

  • Compare periprocedural and long-term outcomes of self-expanding (SEV) versus balloon-expandable (BEV) prostheses in TAVR patients with excess aortic calcification.
  • Evaluate the safety and efficacy of different TAVR valve types in complex calcific aortic stenosis.

Main Methods:

  • Prospective registry analysis of 1,345 patients with severe aortic stenosis and high aortic valve calcium volume (≥235 mm³).
  • 1:1 propensity-matched analysis comparing CoreValve/Evolut SEV and SAPIEN BEV from August 2007 to June 2023.
  • Assessment of procedural success, annular rupture, transprosthetic gradients, paravalvular regurgitation, pacemaker implantation, and mortality at 5 years.

Main Results:

  • Procedural success was >85% in both groups; annular rupture was more frequent with BEV (2.2% vs. 0%, P=.030).
  • SEV showed lower gradients (8.0 vs. 11.2 mmHg, P<.001) but higher mild/greater paravalvular regurgitation (69.7% vs. 58.1%, P=.008) and pacemaker implantation (22.6% vs. 15.5%, P=.001).
  • No significant difference in 5-year mortality between SEV and BEV groups (45.1% vs. 50.2%, P=.173).

Conclusions:

  • In TAVR with excessive calcification, BEV carries a higher risk of annular rupture, while SEV has higher rates of paravalvular regurgitation and pacemaker implantation.
  • Both SEV and BEV demonstrate comparable 5-year mortality in patients with excessive aortic calcification undergoing TAVR.
  • Choice of TAVR prosthesis in calcified aortic valves involves balancing risks of annular rupture, regurgitation, and conduction disturbances.
Abstract

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