Choosing Between Self-Expanding and Balloon-Expandable Valves in Heavily Calcified Aortic Stenosis
Choosing Between Self-Expanding and Balloon-Expandable Valves in Heavily Calcified Aortic Stenosis
Primary Study Source: American Heart Journal, 18 September ,2025
Key Points:
1. In patients with excessive aortic cusp calcification, 5-year mortality is similar between self-expanding and balloon-expandable TAVR devices.
2. Heavy cusp calcification increases risks of underexpansion, malpositioning, migration, stroke, conduction disturbances, paravalvular regurgitation, coronary obstruction, and annular rupture.
3. The study analyzed 271 matched patient pairs (SwissTAVI Registry, 2007–2023) with calcium volume ≥ 235 mm³.
4. Device-specific findings:
• Self-expanding valves → lower mean gradient (8 mmHg vs 11.2 mmHg)
• Balloon-expandable valves → higher rates of annular rupture (2.2%) and cardiac tamponade (1.8%)
• Self-expanding valves → more paravalvular regurgitation (69.7% vs 58.1%) and pacemaker need (22.6% vs 15.5%)
5. At 5 years:
• All-cause mortality: 45.1% (self-expanding) vs 50.2% (balloon-expandable)
• Cardiovascular death: 34.9% vs 39.5%
• No significant differences in stroke, MI, or bleeding outcomes
6. Conclusion: Balloon-expandable valves carry higher procedural risks in severe calcification, while self-expanding valves show more long-term conduction and leak issues. A tailored device selection based on anatomy, comorbidities, and operator expertise is essential.
