Among patients treated with newer-generation transcatheter valves, SEV demonstrated more favorable hemodynamic performance compared with BEV, though short- and mid-term mortality rates remained similar between the two groups.
Key Findings
Methods
Propensity score matching produced 354 well balanced pairs of BEV and SEV patients for comparison.
Single-center retrospective analysis of patients undergoing TAVI for severe native aortic stenosis between January 2018 and December 2023.
Exclusion criteria included emergency procedures, active endocarditis, prior aortic valve interventions, bicuspid valves, primary aortic regurgitation, non-transfemoral access, concomitant coronary procedures, and use of retracted valves.
Propensity score matching was used to create 354 well balanced pairs.
Bioprosthetic valve dysfunction (BVD) was assessed according to modified VARC-3 definitions.
Results
Periprocedural outcomes, including mortality, were comparable between the matched BEV and SEV groups.
No statistically significant differences in periprocedural mortality were observed between the two groups.
This finding applied across the matched cohort of 354 pairs.
Comparability was established after propensity score matching to control for baseline differences.
Results
At discharge, the BEV group demonstrated significantly higher mean transvalvular gradients and peak velocities compared to the SEV group.
Mean transvalvular gradients were significantly higher in the BEV group (P < 0.001).
Peak velocities were also significantly higher in the BEV group (P < 0.001).
These differences were detected on echocardiographic evaluation at discharge.
These findings indicate less favorable immediate hemodynamic performance for BEV compared to SEV.
Results
During follow-up, the SEV group showed a significantly lower incidence of bioprosthetic valve dysfunction (BVD) compared to the BEV group.
Hazard ratio for BVD favored SEV: HR 0.64, 95% CI 0.45–0.91, P = 0.013.
The difference in BVD was driven particularly by higher rates of severe prosthesis-patient mismatch in the BEV group (P = 0.001).
At least moderate structural valve deterioration was also more frequent in the BEV group (P = 0.006).
BVD was assessed using modified VARC-3 definitions.
Results
All-cause mortality and cardiac-related mortality during follow-up did not differ significantly between BEV and SEV groups.
All-cause mortality: HR 1.18, 95% CI 0.90–1.56, P = 0.235.
Cardiac-related mortality: HR 1.29, 95% CI 0.91–1.83, P = 0.157.
Neither result reached statistical significance, indicating similar mid-term survival regardless of valve type.
The authors note that longer-term follow-up of randomized trials is needed to confirm these findings.
What This Means
This research suggests that among patients who received newer-generation transcatheter heart valves (valves inserted through a catheter rather than open-heart surgery) for severe aortic stenosis, the type of valve used affects how well the valve functions over time. Specifically, self-expanding valves (SEV) produced better blood flow measurements immediately after the procedure and were associated with fewer cases of valve malfunction during follow-up, including less severe mismatch between the valve size and the patient's anatomy and less structural deterioration of the valve itself.
Despite these hemodynamic differences, the study found no significant difference in survival rates between patients who received balloon-expandable valves (BEV) and those who received self-expanding valves. Both groups had similar rates of death from all causes and from cardiac causes during the follow-up period. Complications occurring around the time of the procedure were also similar between the two groups.
This research suggests that while the choice between newer-generation balloon-expandable and self-expanding transcatheter valves may not affect short- to mid-term survival, self-expanding valves may offer hemodynamic advantages that could become clinically meaningful over longer time periods. The authors emphasize that longer-term data from randomized controlled trials are needed to determine whether these differences in valve performance ultimately translate into differences in patient survival or quality of life.