Balloon-Expandable Vs Self-Expanding Valves for Transcatheter Aortic Valve Implantation in Internally Stented Surgical Valves

Internally stented (IS) surgical valves, such as Mitroflow (Sorin Group, Arvada, CO) and Trifecta (St. Jude Medical), are known to carry an elevated risk for coronary artery obstruction during valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) procedures. The data from comparison between balloon-expandable valves (BEVs) and supra-annular self-expanding valves (SEVs) for ViV-TAVI within the IS valve remains unclear. This study aimed to evaluate clinical and hemodynamic outcomes of using BEVs and SEVs for TAVI within an IS valve.

Between January 2016 and February 2024, propensity score-matching was performed between BEV and SEV groups in patients undergoing ViV-TAVI within an IS valve. The data of baseline characteristics, hemodynamic parameters, and clinical outcomes were retrospectively collected. Primary endpoints were 30-day and 2-year clinical outcomes, including all-cause death, hospitalization for heart failure, and coronary obstruction.

In total, 113 patients were included in this analysis. A total of 63 patients (55.8%) underwent BEV implantation, and 50 patients (44.2%) underwent SEV implantation. Overall, 37 pairs were identified after propensity-score matching. At day 30, the clinical and hemodynamic outcomes were similar between the groups. Patients with an SEV had better post-procedural mean gradient at 1 year compared with those with a BEV (11.7 ± 4.3 mm Hg vs 22.7 ± 8.4 mm Hg; P < 0.001). No significant difference was observed between SEVs and BEVs in the cumulative 2-year composite endpoint (log-rank P = 0.489).

In patients who underwent ViV within an IS valve, the early- and midterm clinical outcomes were comparable between BEVs and SEVs. However, use of an SEV was associated with superior hemodynamics at 1-year follow-up, vs a BEV.