Third Generation Balloon-Expandable and Self-Expanding Valves: TAVR Meta- Analysis

TAVR’s significant advance has driven the development of valve technology, which is currently in its third generation. 

TAVI: Balón expandible o autoexpandible ¿Cuál es la respuesta?

Even though outcomes have improved, randomized studies are yet to compared balloon-expandable (BEV) vs self-expanding (SEV) valves in randomized studies, and we only have information from different analysis with contradicting conclusions. 

This was a meta-analysis of 16 studies including 10,174 patients, 5,753 receiving BEV and 4,421 SEV. 

The primary outcome was all cause mortality at one-year follow-up. 

Patient mean age was 81, 61% were women, left ventricular ejection fraction was 57% and STS score was 5.1%.

There was no difference in primary end point between both third generation valves (OR, 1.15; CI 95%, 0.89-1.48; P = .29; I2 = 16.4%), or in rehospitalization for cardiac failure (OR, 0.90; CI 95%, 0.65-1.24; P = .50; I2 = 11.5%).

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BEV were associated to lower risk of stroke/TIA (OR, 0.62; CI 95%, 0.44-0.87), need for definite pacemaker implantation (OR, 0.55; CI 95%, 0.44-0.70) and moderate paravalvular leaks (OR, 0.43; CI 95%, 0.25-0.75), but also with higher risk of moderate prosthetis mismatch (OR, 3.76; CI 95%, 2.33-6.05), higher mean gradient (DMP, 4.35; CI 95%, 3.63-5.08) and smaller effective area (DMP, -0.30; CI 95%, -0.37 a -0.23) vs SEV.


This meta-analysis has shown that in third generation TAVR, BEV were associated with similar all causer mortality, lower risk of stroke/TIA, need for pacemaker implantation and moderate paravalvular leak, but higher risk of moderate prosthetis mismatch, higher mean gradient and smaller effective area, compared against SEV. 

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of

Original Title: Outcomes of Transcatheter Aortic Valve Replacement Using Third-Generation Balloon-Expandable Versus Self-Expanding Valves: A Meta-Analysis.

Reference: Saman Asad Siddiqui, et al.

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