Balloon‐Expandable Versus Self‐Expanding Valves in Low‐Flow, Low‐Gradient Aortic Stenosis: Does Valve Type Matter?

BACKGROUND: The optimal choice between balloon-expandable (BE) and self-expanding (SE) transcatheter heart valves (THVs) in patients with low-flow low-gradient aortic stenosis (LFLG AS) undergoing transcatheter aortic valve replacement (TAVR) remains unclear. AIMS: This study aims to compare outcomes of BE THVs and SE THVs in patients with LFLG AS. METHODS: ) were stratified by respective valve type. Patients with prior aortic valve replacement were excluded. Postoperative outcomes were compared between groups. Kaplan-Meier estimates and a Cox regression model were generated for survival. Cumulative incidence curves and a cause-specific cox regression model were generated for heart failure (HF) readmission. RESULTS: A total of 732 patients identified underwent TAVR for LFLG AS. Of these, 478 (65.3%) received a BE THV and 254 (34.7%) received a SE THV. STS PROM was similar between groups. There was no difference in 30-day mortality between groups. SE THVs had a lower mean gradient but increased rates of paravalvular leak at 30 days post-TAVR. Kaplan-Meier estimates were comparable between groups and there was no significant difference after multivariable analysis (HR 1.15, 95% CI 0.90-1.46, p = 0.27). Cumulative incidence estimates of HF readmission were similar between groups, however, BE THV was associated with reduced hazard of HF readmission on multivariable analysis (HR 0.77, 95% CI 0.59-0.99, p = 0.04). CONCLUSIONS: In patients with LFLG AS undergoing TAVR, BE and SE THVs have comparable midterm survival. BE THVs have a reduced risk of HF readmission on multivariable analysis.