Real-World Comparison of Balloon-Expandable Valves for Transcatheter Aortic Valve Replacement: Data From the Aortic+Mitral TRAansCatheter Valve Registry.

Background: Comparative real-world data on newer balloon-expandable valve (BEV) platforms remain limited. We sought to compare clinical, procedural, and early hemodynamic outcomes following transcatheter aortic valve replacement (TAVR) using 2 contemporary BEVs in a multicenter international registry. Methods: Consecutive patients undergoing TAVR with Sapien 3/Ultra and MyVal from the Aortic+Mitral TRAansCatheter Valve Registry were included. Propensity score matching was used to generate a balanced 1:3 cohort. The primary endpoint was 2-year all-cause mortality. Secondary endpoints included in-hospital complications, defined according to Valve Academic Research Consortium-3 criteria. Results: A total of 1903 patients undergoing TAVR with BEV were included (Sapien, n = 1676; MyVal, n = 227). Baseline clinical and echocardiographic characteristics were largely comparable between groups. In the propensity-matched cohort (n = 743), 2-year all-cause mortality did not differ between groups. In-hospital mortality and major procedural complications were similar across platforms. New permanent pacemaker implantation occurred more frequently with MyVal compared with Sapien (26.6% vs. 10.1%; Conclusions: In this analysis, both BEV platforms demonstrated comparable safety, mortality, and overall hemodynamic performance following TAVR. However, MyVal was associated with higher rates of permanent pacemaker implantation and PVL. These findings highlight important platform-specific differences that may inform valve selection and warrant further long-term evaluation.