Balloon-Expandable vs. Self-Expanding TAVR Prostheses for Small Failed Surgical Valves

A small, randomized trial demonstrated significant improvement in 30-day hemodynamic results with the self-expanding device.

In this randomized multicenter study, investigators compared hemodynamic outcomes of balloon-expandable and self-expanding transcatheter aortic valve replacement (TAVR) prostheses in patients with failed small (≤23 mm) surgical valves (NCT03520101). The mode of failure was stenosis in two thirds of patients and regurgitation in one third at a mean of 11 years after initial surgery. The primary outcome was echocardiographic valve hemodynamics, including residual transvalvular gradient and incidence of severe prosthesis–patient mismatch (PPM) or moderate–severe aortic regurgitation at 30 days.

Among 98 patients (mean age, 80 years; about 50% women), results were as follows:

The mean echocardiographic gradient was significantly lower with self-e…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)