Balloon-Expandable Versus Self-Expanding Valves in Low-Flow, Low-Gradient Aortic Stenosis: Does Valve Type Matter?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Low-flow low-gradient aortic stenosis (LFLG AS) poses treatment challenges.
• The choice between balloon-expandable (BE) and self-expanding (SE) transcatheter heart valves (THVs) for TAVR in LFLG AS is not well-defined.

Purpose of the Study:

• To compare the clinical outcomes of BE THVs versus SE THVs in patients with LFLG AS undergoing TAVR.
• To assess differences in survival and heart failure readmission rates between BE and SE THV groups.

Main Methods:

• Retrospective cohort study of 732 patients with LFLG AS undergoing TAVR (2012-2024).
• Patients were stratified by THV type: BE (n=478) or SE (n=254).
• Outcomes including mortality, gradients, paravalvular leak, survival (Kaplan-Meier, Cox regression), and heart failure readmission (cumulative incidence, Cox regression) were analyzed.

Main Results:

• No significant difference in 30-day mortality or midterm survival between BE and SE THV groups.
• SE THVs showed a lower mean gradient post-TAVR but higher rates of paravalvular leak at 30 days.
• BE THVs were associated with a reduced hazard of heart failure readmission (HR 0.77, p=0.04) on multivariable analysis.

Conclusions:

• Both BE and SE THVs offer comparable midterm survival for LFLG AS patients undergoing TAVR.
• Balloon-expandable THVs demonstrate a potential benefit in reducing heart failure readmissions in this patient population.