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Updated: Jul 2, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Self-expanding versus balloon-expandable valves in patients undergoing urgent or emergent TAVI
Anastasios Apostolos1, Konstantinos Konstantinou1, Mohammed Allaf1
1Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Background:
Transcatheter Aortic Valve Implantation (TAVI) is an effective therapy in patients with severe aortic stenosis presenting in acute heart failure, though whether self-expanding (SEV) or balloon-expandable valves (BEV) should be used in such cases is unknown. The aim of the study is to compare SEV with BEV in such patients.
Methods:
Consecutive patients undergoing urgent TAVI with either SEV or BEV at two tertiary hospitals between 2012 and 2024 were studied. The primary endpoint was long-term survival over a median follow-up of 60 months. Secondary endpoints included technical and device success, in-hospital mortality, periprocedural complications, and echocardiographic valve performance. A subgroup analysis evaluated more contemporary devices (after 1/1/2017).
Results:
A total of 587 patients underwent urgent TAVI [SEV (N = 321) and BEV (N = 266)]. BEV patients had higher rates of prior myocardial infarction and stroke. BEV achieved higher technical and device success, lower in-hospital mortality, and less post-TAVI aortic regurgitation. Although Kaplan-Meier analysis suggested better survival with BEV (log-rank p = 0.017) adjusted Cox regression revealed no significant mortality difference (HR 0.73, 95%CI 0.51-1.04). Outcomes were also comparable in the contemporary device subgroup (n = 299).
Conclusions:
To the best of our knowledge, this is the first analysis comparing long-term outcomes in patients presenting in acute heart failure undergoing urgent TAVI between SEV and BEV. No statistically significant difference in long-term survival was observed between SEV and BEV, supporting individualized device selection based on anatomy and operator preference.
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