Mid-term outcomes of balloon-expandable vs. self-expanding valves for valve-in-valve TAVR: Insights from the Michigan Structural Heart Consortium.
Recommended Citation
Jabri A, Kumar S, Abbas A, Fang JX, Madanat L, Grossman P, Seth M, Chetcuti S, Mantey J, Suri R, Vivacqua A, Schwann T, Dixon S, Sukul D, and Villablanca PA. Mid-term outcomes of balloon-expandable vs. self-expanding valves for valve-in-valve TAVR: Insights from the Michigan Structural Heart Consortium. Cardiovasc Revasc Med 2025.
Document Type
Article
Publication Date
10-17-2025
Publication Title
Cardiovasc Revasc Med
Keywords
Balloon-expandable valve; Patient-prosthesis mismatch; Self-expanding valve; Valve-in-valve TAVR
Abstract
BACKGROUND: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) is used for degenerated surgical bioprosthetic valves. Comparative outcomes between balloon-expandable valves (BEV) and self-expanding valves (SEV) remain scarce, particularly regarding long-term survival.
METHODS: We conducted a retrospective cohort study using data from the Michigan Structural Heart Consortium (MISHC), a multicenter collaborative focused on quality improvement for structural heart interventions. Clinical outcomes, including mortality, were evaluated. Logistic regression adjusted for age, gender, and STS risk score assessed in-hospital, 30-day, and 1-year mortality. Kaplan-Meier and Cox regression analyzed five-year survival with similar adjustments.
RESULTS: Between 2013 and 2023, 1394 patients underwent ViV TAVR, with 683 (49.0 %) being BEV and 711 (51.0 %) being SEV. Patients who received BEV demonstrated significantly lower pre-procedural mean aortic gradients than those receiving SEV (35.94 ± 16.20 vs. 39.11 ± 16.17 mmHg, p = 0.002) and larger pre-procedural aortic valve areas (0.94 ± 0.55 cm(2) BEV vs. 0.85 ± 0.40 cm(2) SEV; p = 0.005). In-hospital mortality (1.2 % vs. 3.0 %, p = 0.032) and 30-day mortality (2.2 % vs. 4.1 %, p = 0.040) were significantly lower with BEV after ViV TAVR. Severe patient-prosthesis mismatch (PPM) was higher with BEV than SEV (47.9 % vs. 24.3 %, p < 0.001). At one year, mortality did not differ significantly (8.6 % BEV vs. 8.2 % SEV, p = 0.495). Five-year survival rates were similar between groups (p = 0.880).
CONCLUSION: In ViV TAVR, no significant survival differences were observed at 5-year follow-up, despite a higher prevalence of severe PPM in the BEV group.
PubMed ID
41125469
ePublication
ePub ahead of print
