Comparative outcomes of balloon-expandable and self-expanding valves in transcatheter aortic valve replacement: A systematic review and meta-analysis

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology Pub Date : 2026-10-01 Epub Date: 2026-06-17 DOI:10.1016/j.jjcc.2026.06.009

Abdelrahman Hafez MD, Ahmed Sobhy MD, Ahmed Elshahat MD, Dara Bruce MS, Omar Abdulrahman Saad MBBCh, Mennatullah Ashour MBBCh, Karim Ali MD, Mohamed A. Shebl MD, Anmolika K. Bolla BS, Reyan Usmani BS, Mahmoud Aboudabash MBBCh, Amr Arafa MD, Shaimaa A. Shehata MD, Nouran Abdellatif MBBS, Abdalrahman Alagab MD, Ahmed Eldessouki, Richie Riccelli, Deepak Gir MD, Ghada Y.A. Elzewiei MD, Eman A. Toraih MD, PhD, MS, Hani Aiash MD, PhD

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引用次数: 0

Abstract

Background

Balloon-expandable valves (BEVs) and self-expanding valves (SEVs) are the two primary platforms for transcatheter aortic valve replacement (TAVR), differing in design, deployment, and hemodynamic performance. Comparative evidence on their clinical and procedural outcomes remains limited and inconsistent.

Methods

A systematic review and meta-analysis were conducted, searching PubMed, Scopus, Web of Science, and Cochrane Library up to July 2025 for studies comparing BEVs and SEVs in adults with severe aortic stenosis undergoing transfemoral TAVR. Outcomes included all-cause mortality, cardiovascular mortality, stroke, permanent pacemaker implantation, hemodynamic parameters, device success, and safety endpoints. Dichotomous and continuous outcomes were pooled as risk ratios (RR) and mean differences (MD) with corresponding 95% confidence intervals (CI) using a random-effects model.

Results

Fifty-three studies (n = 157,921) were included (6 randomized controlled trials, 12 prospective, and 35 retrospective cohorts). BEVs showed significant early survival benefits at 1 month (RR = 0.75, 95% CI 0.57–0.97, p = 0.03) and 6 months (RR = 0.33, 95%CI0.18–0.60, p < 0.001), with reduced cardiovascular mortality at 12 months (RR = 0.88, 95% CI 0.79–0.99, p = 0.03). Permanent pacemaker implantation rates were consistently lower with BEVs (e.g. RR = 0.75, 95% CI 0.64–0.88, p < 0.001 at 1 month). SEVs exhibited superior hemodynamics, with lower mean gradients (MD = −3.16 to −7.77 mmHg) and larger aortic valve areas (MD = +0.11 to +0.13 cm²). Long-term mortality and safety outcomes, including major bleeding, vascular complications, and myocardial infarction, were comparable.

Conclusion

BEVs offer early survival and conduction preservation advantages, while SEVs provide superior hemodynamic performance. These findings highlight the importance of individualized valve selection based on patient-specific factors. Further randomized trials with extended follow-up are needed to evaluate long-term durability and outcomes in diverse patient populations.

查看原文本刊更多论文

经导管主动脉瓣置换术中球囊扩张和自扩张瓣膜的比较结果：一项系统综述和meta分析。

背景：球囊膨胀瓣膜（bev）和自膨胀瓣膜（sev）是经导管主动脉瓣置换术（TAVR）的两个主要平台，在设计、部署和血流动力学性能上有所不同。关于其临床和手术结果的比较证据仍然有限且不一致。方法：系统回顾和荟萃分析，检索PubMed、Scopus、Web of Science和Cochrane Library截至2025年7月的研究，比较bev和sev在成人重度主动脉瓣狭窄患者行经股动脉瓣膜置换术中的应用。结果包括全因死亡率、心血管死亡率、卒中、永久性起搏器植入、血流动力学参数、装置成功和安全性终点。使用随机效应模型将二分类和连续结局合并为风险比（RR）和平均差异（MD），并给出相应的95%置信区间（CI）。结果：纳入53项研究（n = 157,921）（6项随机对照试验，12项前瞻性和35项回顾性队列）。成为了重要的生存利益1 月初(RR = 0.75,95%可信区间0.57 - -0.97,p = 0.03)和6 月(RR = 0.33,95% ci0.18 - 0.60, p 2)。包括大出血、血管并发症和心肌梗死在内的长期死亡率和安全性结果具有可比性。结论：bev具有早期存活和传导保存的优势，而sev具有更好的血流动力学性能。这些发现强调了基于患者特定因素的个体化瓣膜选择的重要性。需要进一步的随机试验，延长随访时间，以评估不同患者群体的长期持久性和结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.