Outcomes of balloon-expandable versus self-expandable valves in TAVR for mixed aortic valve disease

The ideal valve choice for patients with mixed aortic stenosis defined as severe aortic stenosis with concomitant moderate or greater aortic regurgitation (AR) at the time of transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to compare outcomes between balloon-expandable valves (BEV) and self-expanding valves (SEV) in patients with mixed aortic valve disease undergoing TAVR.

A retrospective analysis was performed using prospectively collected institutional data from January 2012 to November 2024. Patients with trace/mild AR, or valve-in-valve procedures were excluded. After 1:1 propensity score matching, clinical and echocardiographic outcomes were compared. Endpoints were defined according to Valve Academic Research Consortium-3 criteria.

A total of 796 patients with mixed aortic valve disease underwent TAVR with either a BEV (n = 474) or SEV (n = 322). Propensity score matching was performed to create balanced cohorts (n = 286 per group) based on baseline characteristics. Clinical outcomes were similar between groups except the incidence of stroke (p < 0.001) and major vascular complications (p = 0.015) was notably higher with SEV. The SEV group exhibited a significantly lower aortic valve mean gradient at 30 days (7.92 ± 4.11 mmHg vs. 12.1 ± 4.51 mmHg, p < 0.001) and 1 year (8.53 ± 4.33 mmHg vs 12.5 ± 6.85 mmHg, p < 0.001). Despite a higher paravalvular leak rate in the SEV group at 30 days, this did not persist at 1 year (p = 0.77). There was no significant difference in estimated mortality at 1 and 5 years.

In patients with mixed aortic valve disease, TAVR with SEV resulted in superior hemodynamic performance but was associated with a higher rate of paravalvular leak, stroke, and major vascular complications in the short-term. While long-term survival was similar between groups, further investigation is warranted to optimize valve selection in these patients.