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Updated: Feb 25, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Balloon-Expandable Versus Self-Expanding Valves in Low-Flow, Low-Gradient Aortic Stenosis: Does Valve Type Matter?
Nav Warraich1, James A Brown1, Abbad Sultan1
1Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Background:
The optimal choice between balloon-expandable (BE) and self-expanding (SE) transcatheter heart valves (THVs) in patients with low-flow low-gradient aortic stenosis (LFLG AS) undergoing transcatheter aortic valve replacement (TAVR) remains unclear.
Aims:
This study aims to compare outcomes of BE THVs and SE THVs in patients with LFLG AS.
Methods:
This was a retrospective, single-institution cohort study of TAVR procedures between 2012 and 2024. Patients with LFLG AS (mean gradient < 40 mmHg and ejection fraction < 50% or stroke volume index < 35 mL/m2) were stratified by respective valve type. Patients with prior aortic valve replacement were excluded. Postoperative outcomes were compared between groups. Kaplan-Meier estimates and a Cox regression model were generated for survival. Cumulative incidence curves and a cause-specific cox regression model were generated for heart failure (HF) readmission.
Results:
A total of 732 patients identified underwent TAVR for LFLG AS. Of these, 478 (65.3%) received a BE THV and 254 (34.7%) received a SE THV. STS PROM was similar between groups. There was no difference in 30-day mortality between groups. SE THVs had a lower mean gradient but increased rates of paravalvular leak at 30 days post-TAVR. Kaplan-Meier estimates were comparable between groups and there was no significant difference after multivariable analysis (HR 1.15, 95% CI 0.90-1.46, p = 0.27). Cumulative incidence estimates of HF readmission were similar between groups, however, BE THV was associated with reduced hazard of HF readmission on multivariable analysis (HR 0.77, 95% CI 0.59-0.99, p = 0.04).
Conclusions:
In patients with LFLG AS undergoing TAVR, BE and SE THVs have comparable midterm survival. BE THVs have a reduced risk of HF readmission on multivariable analysis.
