Comparative Outcomes of Self-Expanding Versus Balloon-Expandable Valves in Severe Aortic Stenosis: A Systematic...

Abstract: Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis, with self-expanding valves (SEV) and balloon-expandable valves (BEV) representing the two major platforms. However, their comparative clinical and hemodynamic performance remains uncertain. We systematically searched four electronic databases through August 2026 for studies comparing SEV and BEV in patients undergoing TAVR. The primary outcomes were permanent pacemaker implantation (PPI) and change in mean pressure gradient (MPG), while secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), stroke, paravalvular leakage (PVL), heart failure hospitalization, coronary obstruction, and prosthesis-patient mismatch (PPM). Twenty-three studies involving 21,609 patients were included. Compared with BEV, SEV was associated with a significantly greater reduction in MPG (MD -4.48, 95% CI -5.29 to -3.67; P < 0.0001) and lower risks of moderate (RR 0.56, 95% CI 0.42-0.75) and severe PPM (RR 0.33, 95% CI 0.25-0.44). Conversely, SEV was associated with higher risks of PPI (RR 1.40, 95% CI 1.14-1.72; P < 0.0001), moderate-to-severe PVL (RR 2.28, 95% CI 1.65-3.14; P < 0.0001), and a small but significant increase in all-cause mortality. No significant differences were observed in MACE, stroke, heart failure hospitalization, or coronary obstruction..