Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Replacement
Authors: Eric Van Belle, Flavien Vincent, Julien Labreuche, Vincent Auffret, Nicolas Debry, Thierry Lefèvre, Helene Eltchaninoff, Thibaut Manigold, Martine Gilard, Jean-Phillipe Verhoye, Dominique Himbert, Rene Koning, Jean-Phillipe Collet, Pascal Leprince, Emmanuel Teiger, Alain Duhamel, Alessandro Cosenza, Guillaume Schurtz, Sina Porouchani, Benoit Lattuca, Emmanuel Robin, Augustin Coisne, Thomas Modine, Marjorie Richardson, Patrick Joly, Gilles Rioufol, Said Ghostine, Olivier Bar, Nicolas Amabile, Didier Champagnac, Patrick Ohlmann, Nicolas Meneveau, Thibaut Lhermusier, Lionel Leroux, Florence Leclercq, Thomas Gandet, Frédéric Pinaud, Thomas Cuisset, Pascal Motreff, Géraud Souteyrand, Bernard Iung, Thierry Folliguet, Philippe Commeau, Guillaume Cayla, Gilles Bayet, Olivier Darremont, Christian Spaulding, Hervé Le Breton, Cédric Delhaye
Journal: Circulation (2019)

Background: No randomized study powered to compare balloon expandable (BE) with self expanding (SE) transcatheter heart valves (THVs) on individual end points after transcatheter aortic valve replacement has been conducted to date. Methods: From January 2013 to December 2015, the FRANCE-TAVI nationwide registry (Registry of Aortic Valve Bioprostheses Established by Catheter) included 12 141 patients undergoing BE-THV (Edwards, n=8038) or SE-THV (Medtronic, n=4103) for treatment of native aortic stenosis. Long term mortality status was available in all patients (median 20 months; interquartile range, 14 to 30). Patients treated with BE-THV (n=3910) were successfully matched 1:1 with 3910 patients treated with SE-THV by using propensity score (25 clinical, anatomical, and procedural variables) and by date of the procedure (within 3 months). The first coprimary outcome was ≥ moderate occurrence of paravalvular regurgitation or in-hospital mortality, or both. The second coprimary outcome was 2-year all-cause mortality. Results: In propensity–matched analyses, the incidence of the first coprimary outcome was higher with SE-THV (19.8%) compared with BE-THV (11.9%; relative risk, 1.68 [95% CI, 1.46–1.91]; P &lt;0.0001). Each component of the outcome was also higher in patients receiving SE-THV: ≥ moderate paravalvular regurgitation (15.5% versus 8.3%; relative risk, 1.90 [95% CI, 1.63–2.22]; P &lt;0.0001) and in hospital mortality (5.6% versus 4.2%; relative risk, 1.34 [95% CI, 1.07–1.66]; P =0.01). During follow up, all cause mortality occurred in 899 patients treated with SE-THV (2-year mortality, 29.8%) and in 801 patients treated with BE-THV (2-year mortality, 26.6%; hazard ratio, 1.17 [95% CI, 1.06–1.29]; P =0.003). Similar results were found using inverse probability of treatment weighting using propensity score analysis. Conclusion: The present study suggests that use of SE-THV was associated with a higher risk of paravalvular regurgitation and higher in-hospital and 2-year mortality compared with use of BE-THV. These data strongly support the need for a randomized trial sufficiently powered to compare the latest generation of SE-THV and BE-THV. Clinical Trial Registration: https://www.clinicaltrials.gov . Unique identifier: NCT01777828.