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BE and SE TAVI had similar 6-year outcomes. BE had fewer pacemakers but more leaflet thrombosis, while SE saw more transient ischemic attacks. 

As per the 6 Year Follow-Up study in a Propensity-Matched Analysis, published in the June 2025 issue of American Journal of Cardiology, researchers compared the extended outcomes of balloon-expandable (BE) and self-expanding (SE) valves in patients who underwent transcatheter aortic valve implantation (TAVI). 

They performed a comparative analysis of in-hospital, 1-year, and 6-year outcomes in individuals who underwent transfemoral TAVI, including 1,685 BE; S3, Ultra and 776 SE; Evolut R, PRO, PRO+ cases. Valve-in-valve procedures and non-transfemoral access cases were excluded. Propensity score matching yielded 683 BE and 680 SE cases. Matched groups showed no significant differences in age (82.2±8.0 vs 82.1±7.8 years, P=0.407), baseline demographics, comorbidities, pre-TAVI echocardiography and cardiac catheterization findings, or Society of Thoracic Surgeons (STS) Risk Score (7.9±5.9% vs 7.9±5.5%, P=0.481).  

The results showed that recipients of BE and SE TAVI had comparable in-hospital mortality (0.9% vs 0.6%, P=0.072), stroke rates (1.3% vs 1.8%, P=0.503), major vascular complications (2.8% vs 2.2%, P=0.495), and composite bleeding events (4.7% vs 3.4%, P=0.178). The need for permanent pacemaker implantation was lower in the BE group (8.3% vs 13.3%, P=0.003). At 1 year, both groups had similar all-cause mortality (10.8% vs 11.2%, P=0.825), hospital readmission rates (22.5% vs 19.6%, P=0.192), and Kansas City Cardiomyopathy Questionnaire 12 (KCCQ12) scores (83.7±25.5 vs 83.0±24.6, P=0.606). Median follow-up at 77.0 months (72.6–81.5) showed no significant difference in all-cause mortality (33.2% vs 40.4%, P=0.586) or late aortic valve (AV)–related events, including myocardial infarction, stroke, AV endocarditis, and AV re-intervention (balloon aortic valvuloplasty, percutaneous paravalvular leak closure, repeat TAVI, surgical AV replacement). Subclinical leaflet thrombosis treatment was more frequent in BE cases, whereas recipients of SE had more transient ischemic attacks during follow-up.  

Investigators concluded that patients of BE and SE TAVI had comparable in-hospital, 1-year, and median 6-year outcomes, except for increased subclinical leaflet thrombosis in BE and higher transient ischemic attack rates in recipients of SE. 

Source: ajconline.org/article/S0002-9149(25)00359-5/fulltext