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Balloon-Expandable Versus Self-Expanding Valves in Transcatheter Aortic Valve Replacement for Patients with Left
Berhan Keskin1, Aykun Hakgör1, Atakan Dursun1
1Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, Istanbul, Türkiye.
Summary
Transcatheter aortic valve replacement (TAVR) with balloon-expandable valves (BEV) or self-expanding valves (SEV) showed similar long-term survival in patients with severe aortic stenosis and left ventricular systolic dysfunction. Valve type did not impact outcomes in this high-risk group.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Heart Valve Disease
Background:
- Severe aortic stenosis (AS) with left ventricular systolic dysfunction (LVSD) is a fragile subgroup undergoing transcatheter aortic valve replacement (TAVR).
- Comparative outcome data for balloon-expandable valves (BEV) and self-expanding valves (SEV) in this specific population are limited.
Purpose of the Study:
- To compare the procedural and long-term outcomes of BEV versus SEV in patients with severe AS and LVSD undergoing TAVR.
- To identify predictors of long-term mortality in this high-risk patient cohort.
Main Methods:
- Retrospective single-center study of 246 consecutive patients with left ventricular ejection fraction (LVEF) < 50% undergoing transfemoral TAVR.
- Comparison of clinical, echocardiographic, and procedural characteristics between BEV (n=96) and SEV (n=150) recipients.
- Primary endpoint was long-term all-cause mortality, analyzed using Kaplan-Meier curves and multivariable Cox regression.
Main Results:
- SEV implantation resulted in lower post-procedural transvalvular gradients compared to BEV (7.8 ± 4.0 mmHg vs. 9.6 ± 4.1 mmHg, P=0.001).
- Crude mortality was higher in the BEV group (50.0% vs. 36.0%, P=0.041), but Kaplan-Meier survival analysis showed no significant difference in long-term survival (log-rank P=0.92).
- Multivariable analysis identified older age, COPD, coronary artery disease, lower serum albumin, and lower hemoglobin as predictors of mortality; valve type was not a significant predictor.
Conclusions:
- BEV and SEV demonstrate comparable procedural and long-term outcomes in patients with LVSD undergoing TAVR.
- While SEV may lead to lower postoperative gradients, valve choice did not influence survival in this study.
- Further research with larger cohorts and next-generation devices is needed to optimize valve selection for this vulnerable patient group.
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