Balloon-Expandable Vs Self-Expanding Valves for Transcatheter Aortic Valve Implantation in Internally Stented Surgical Valves.

Background: Internally stented (IS) surgical valves, such as Mitroflow (Sorin Group, Arvada, CO) and Trifecta (St. Jude Medical), are known to carry an elevated risk for coronary artery obstruction during valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) procedures. The data from comparison between balloon-expandable valves (BEVs) and supra-annular self-expanding valves (SEVs) for ViV-TAVI within the IS valve remains unclear. This study aimed to evaluate clinical and hemodynamic outcomes of using BEVs and SEVs for TAVI within an IS valve. Methods: Between January 2016 and February 2024, propensity score-matching was performed between BEV and SEV groups in patients undergoing ViV-TAVI within an IS valve. The data of baseline characteristics, hemodynamic parameters, and clinical outcomes were retrospectively collected. Primary endpoints were 30-day and 2-year clinical outcomes, including all-cause death, hospitalization for heart failure, and coronary obstruction. Results: In total, 113 patients were included in this analysis. A total of 63 patients (55.8%) underwent BEV implantation, and 50 patients (44.2%) underwent SEV implantation. Overall, 37 pairs were identified after propensity-score matching. At day 30, the clinical and hemodynamic outcomes were similar between the groups. Patients with an SEV had better post-procedural mean gradient at 1 year compared with those with a BEV (11.7 ± 4.3 mm Hg vs 22.7 ± 8.4 mm Hg; Conclusions: In patients who underwent ViV within an IS valve, the early- and midterm clinical outcomes were comparable between BEVs and SEVs. However, use of an SEV was associated with superior hemodynamics at 1-year follow-up, vs a BEV.