The Particulars: Transcatheter aortic valve replacement (TAVR) can utilize either balloon-expandable valves or self-expandable valves. A randomized comparison of the two methods has yet to be performed.
Data Breakdown: Patients with severe aortic stenosis and an anatomy suitable for transfemoral TAVR who participated in a study were randomly assigned to receive a balloon-expandable valve or a self-expandable valve. Device success was achieved in 95.9% of patients in the balloon-expandable valve group, compared with a rate of 77.5% in the self-expandable valve group. The difference in these rates was attributable to a significantly lower frequency of residual more-than-mild aortic regurgitation (4.1% vs 18.3%) and a less frequent need for implanting more than one valve (0.8% vs 5.8%) in the balloon-expandable valve group. Cardiovascular mortality at 30 days, bleeding, and vascular complications were similar between the groups. Rates of new permanent pacemaker placement were 17.3% in the balloon-expandable valve group and 37.6% in the self-expandable valve group.
Take Home Pearls: Use of balloon-expandable valves appears to result in a greater rate of device success than use of self-expandable valves among patients with high-risk aortic stenosis who are undergoing TAVR.