Balloon-versus Self-expandable Transcatheter Aortic Valve Implantation in Small Aortic Annuli: a Meta-analysis of Randomized and Propensity Studies

Overview

Journal Cardiovasc Interv Ther

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2025 Feb 18

PMID 39964636

Authors

Massimo Baudo

Serge Sicouri

Yoshiyuki Yamashita

Dimitrios Magouliotis

Francesco Cabrucci

Sarah Carnila

Basel Ramlawi

Affiliations

Soon will be listed here.

Abstract

The hemodynamic and clinical differences between balloon- (BEV) and self-expandable valves (SEV) are critical for patients with a small aortic annulus (SAA). This meta-analysis aims to evaluate the clinical and hemodynamic performance of these two systems in patients with severe aortic stenosis and SAA. A systematic review was conducted from inception to June 2024 for randomized and propensity-score studies comparing BEV and SEV outcomes in patients with a SAA. Reconstructed individual patient data (IPD) from Kaplan Meier curves was pooled for overall survival and rehospitalization for heart failure. Nine studies with 2856 patients met our inclusion criteria: 1427 in the BEV group and 1429 in the SEV group. SEV demonstrated superior hemodynamic performance, including improved iEOA (Standardized Mead Difference [SMD]: 0.52, p = 0.0012), lower mean gradients (SMD: - 0.89, p < 0.0001), and reduced PPM (Odds Ratio [OR]: 0.38, p < 0.0001) compared to BEV. BEV presented lower new pacemaker rates compared to SEV (OR: 1.52, p = 0.0447). There were no significant differences between SEV and BEV in terms of rates of > mild paravalvular leaks, early stroke, and Valve Academic Research Consortium-defined outcomes. Reconstructed IPD showed no significant differences in overall survival (Hazard Ratio [HR]: 0.95, p = 0.584) and rehospitalization for heart failure (HR: 1.05, p = 0.828) during follow-up. In patients with SAA undergoing TAVI the use of BEV was associated with higher frequency of PPM and/or pressure gradients. Similar early stroke, survival and rehospitalization rates were reported. Pacemaker rates were higher with SEV. Long-term follow-up studies are required, especially with newer-generation devices.

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