Mid-term outcomes of balloon-expandable vs. self-expanding valves for valve-in-valve TAVR: Insights from the Michigan Structural Heart Consortium.

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 cm2 BEV vs. 0.85 ± 0.40 cm2 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.