7-Year Outcomes of Balloon-Expandable Versus Self-Expanding Valves in Women Undergoing Transcatheter Aortic Valve Replacement

BACKGROUND: Female patients with aortic stenosis frequently present with a small aortic annulus (SAA), which may result in unfavorable echocardiographic cardiac function after transcatheter aortic valve replacement. However, evidence comparing the long-term outcomes of balloon-expandable valves (BEVs) and self-expanding valves (SEVs) in this context is limited. OBJECTIVES: This study compares the 7-year clinical outcomes after transcatheter aortic valve replacement using BEV and SEV in female patients. METHODS: Overall, 1,827 female patients treated with BEV and 805 treated with SEV were identified from the Optimized transCathEter vAlvular intervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry. One-to-one propensity score matching (PSM) was performed to adjust for confounding factors, resulting in 744 matched patients per group. The primary clinical endpoints included all-cause mortality, stroke, and heart failure rehospitalization. RESULTS: Overall, 1,303 patients (87.6%) had a SAA. Echocardiographic assessments indicated that BEV had smaller effective orifice area and higher mean pressure gradient than did SEV throughout the follow-up period. In the PSM analysis, BEV was associated with lower all-cause mortality (51.5% vs 57.4%; log-rank, P = 0.021) and stroke at 7 years (10.8% vs 16.7%; Fine-Gray, P = 0.008). Heart failure rehospitalization rates were similar between groups. In multivariable analyses, valve type was not independently associated with long-term outcomes, and subgroup analyses considering annulus size yielded consistent results. CONCLUSIONS: For women predominantly presenting with a SAA, BEV demonstrated decreased echocardiac performance compared with SEV. Although PSM analysis indicated more favorable outcomes with BEV, valve type was not independently associated with long-term prognosis after multivariable adjustment. These findings suggest that both types of transcatheter heart valves may be an acceptable option in this patient population.