Balloon-expandable versus self-expanding transcatheter aortic valve replacement: a comparison and evaluation of current findings

ABSTRACT

Introduction

Currently, several balloon-expandable (BE) and self-expanding (SE) transcatheter aortic valves (TAVs) are available in clinical practice. Each of them has potential advantages and disadvantages that must be taken into account.

Areas covered

New-generation BE and SE TAVs showed similar mid-term outcomes after transfemoral transcatheter aortic valve replacement (TAVR) and better results compared to early-generation devices.BE TAVs showed better results in terms of residual paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI), whereas SE TAVs had better performance in terms of residual transvalvular gradients, larger effective orifice areas (EOAs) and therefore lower rates of prosthesis-patients mismatch (PPM). On one hand, supra-annular CoreValve/Evolut SE TAVs seems to have better results compared to SAPIEN XT/3 BE valves when used in the setting of valve-in-valve procedures in small bioprostheses. On the other hand, the need of ensuring an easy coronary re-access after TAVR especially in younger patients seems to favor the large cell design of SAPIEN 3/ULTRA BE valves. Finally, first long-term durability reports seem to suggest lower rates of structural valve dysfunction (SVD) with supra-annular SE TAVs.

Expert opinion

Although currently available TAVs showed similar mid-term outcomes, the expansion of TAVR indications toward lower risk, younger patients imposes attention to long-term durability, and to the need of obtaining optimized EOAs and an easy coronary re-access for future percutaneous interventions.

KEYWORDS:

• TAVR
• TAV
• balloon-expandable
• self-expanding
• comparison
• outcomes
• hemodynamic performances
• coronary access
• prosthesis-patient mismatch
• durability

Article highlights

• New-generation BE and SE TAVs showed similar mid-term clinical outcomes but different specific advantages and disadvantages.

• SAPIEN 3/ULTRA BE valve showed the lowest rate of PVR, whereas Evolut R/PRO and ACURATE neo valves yielded lower residual gradients, larger EOAs, and lower PPM rates.

• Evolut R/PRO and Portico valves showed higher rates of PPI.

• CoreValve/Evolut SE valves seem to have better results for ViV procedures in small surgical bioprostheses.

• Coronary re-access after TAVR and bioprostheses’ long-term durability are the main issues to delve into in the upcoming future

Declaration of interest

M Barbanti is consultant for Edwards Lifesciences and an advisory board member for Medtronic and Biotronik. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.