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Balloon-Expandable Versus Self-Expanding Valves in Bicuspid Aortic Stenosis : Insights From the SWEDEHEART Registry

Louca, Antros ; Sundström, Joakim ; Rawshani, Araz ; Hagström, Henrik ; Settergren, Magnus ; James, Stefan ; Koul, Sasha LU ; Skoglund, Kristofer ; Ioanes, Dan and Völz, Sebastian , et al. (2025) In Catheterization and Cardiovascular Interventions 106(4). p.2336-2347
Abstract

Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with bicuspid aortic valve (BAV) stenosis, but there is limited comparative data on balloon-expandable (BEV) versus self-expanding valves (SEV) in this population. Aim: To compare clinical and hemodynamic outcomes between BEVs and SEVs in patients with BAV stenosis. Methods: This observational cohort included all patients who underwent TAVR in Sweden between 2016 and 2022. Exclusion criteria included procedures for pure aortic insufficiency and valve-in-valve interventions. The analysis focused on Evolut, Sapien, Acurate, and Portico/Navitor valve families. A doubly robust approach was applied combining inverse probability of treatment weighting... (More)

Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with bicuspid aortic valve (BAV) stenosis, but there is limited comparative data on balloon-expandable (BEV) versus self-expanding valves (SEV) in this population. Aim: To compare clinical and hemodynamic outcomes between BEVs and SEVs in patients with BAV stenosis. Methods: This observational cohort included all patients who underwent TAVR in Sweden between 2016 and 2022. Exclusion criteria included procedures for pure aortic insufficiency and valve-in-valve interventions. The analysis focused on Evolut, Sapien, Acurate, and Portico/Navitor valve families. A doubly robust approach was applied combining inverse probability of treatment weighting and multivariable regression. Sensitivity analyses were also conducted. Results: Of 577 patients, 274 (47.5%) received a BEV. The majority in the SEV group received an Evolut valve (62%). The mean EUROSCORE II-predicted mortality risk was 4.1% for BEV and 3.6% for SEV. BEVs were used more in patients with reduced ejection fraction (EF ≤ 40%) and larger aortic annuli. There were no significant differences between groups in periprocedural mortality, all-cause mortality at a median follow-up of 675 days, or device success. However, SEVs had higher technical success (aOR: 2.21, p = 0.006), lower postprocedural gradients (adjusted coefficient: −3.72, p < 0.001), and reduced risk of prosthesis-patient mismatch (aOR: 0.10, p = 0.02). SEVs, though, had a higher incidence of paravalvular leakage (aOR: 7.5, p < 0.01). Conclusion: Both BEVs and SEVs were feasible with similar clinical outcomes in BAV stenosis. SEVs had better hemodynamic outcomes but more paravalvular leakage. Randomized trials are needed to determine the optimal valve choice.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
aortic valve stenosis, balloon expandable valves, bicuspid aortic valve, self-expanding valves, transcatheter aortic valve replacement
in
Catheterization and Cardiovascular Interventions
volume
106
issue
4
pages
12 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:40760772
  • scopus:105012394889
ISSN
1522-1946
DOI
10.1002/ccd.70073
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
id
c157d69d-211b-4c27-b038-5bb95fc49083
date added to LUP
2026-01-22 15:00:49
date last changed
2026-01-23 03:00:03
@article{c157d69d-211b-4c27-b038-5bb95fc49083,
  abstract     = {{<p>Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with bicuspid aortic valve (BAV) stenosis, but there is limited comparative data on balloon-expandable (BEV) versus self-expanding valves (SEV) in this population. Aim: To compare clinical and hemodynamic outcomes between BEVs and SEVs in patients with BAV stenosis. Methods: This observational cohort included all patients who underwent TAVR in Sweden between 2016 and 2022. Exclusion criteria included procedures for pure aortic insufficiency and valve-in-valve interventions. The analysis focused on Evolut, Sapien, Acurate, and Portico/Navitor valve families. A doubly robust approach was applied combining inverse probability of treatment weighting and multivariable regression. Sensitivity analyses were also conducted. Results: Of 577 patients, 274 (47.5%) received a BEV. The majority in the SEV group received an Evolut valve (62%). The mean EUROSCORE II-predicted mortality risk was 4.1% for BEV and 3.6% for SEV. BEVs were used more in patients with reduced ejection fraction (EF ≤ 40%) and larger aortic annuli. There were no significant differences between groups in periprocedural mortality, all-cause mortality at a median follow-up of 675 days, or device success. However, SEVs had higher technical success (aOR: 2.21, p = 0.006), lower postprocedural gradients (adjusted coefficient: −3.72, p &lt; 0.001), and reduced risk of prosthesis-patient mismatch (aOR: 0.10, p = 0.02). SEVs, though, had a higher incidence of paravalvular leakage (aOR: 7.5, p &lt; 0.01). Conclusion: Both BEVs and SEVs were feasible with similar clinical outcomes in BAV stenosis. SEVs had better hemodynamic outcomes but more paravalvular leakage. Randomized trials are needed to determine the optimal valve choice.</p>}},
  author       = {{Louca, Antros and Sundström, Joakim and Rawshani, Araz and Hagström, Henrik and Settergren, Magnus and James, Stefan and Koul, Sasha and Skoglund, Kristofer and Ioanes, Dan and Völz, Sebastian and Myredal, Anna and Angerås, Oskar and Petursson, Petur and Råmunddal, Truls}},
  issn         = {{1522-1946}},
  keywords     = {{aortic valve stenosis; balloon expandable valves; bicuspid aortic valve; self-expanding valves; transcatheter aortic valve replacement}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{4}},
  pages        = {{2336--2347}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Catheterization and Cardiovascular Interventions}},
  title        = {{Balloon-Expandable Versus Self-Expanding Valves in Bicuspid Aortic Stenosis : Insights From the SWEDEHEART Registry}},
  url          = {{http://dx.doi.org/10.1002/ccd.70073}},
  doi          = {{10.1002/ccd.70073}},
  volume       = {{106}},
  year         = {{2025}},
}