stroke rates remain comparable between balloon-expandable and self-expanding devices at 30 days, during hospitalization, and at three years," the researchers wrote.
The research, led by Dr. Daniele Giacoppo and colleagues from Azienda Ospedaliero-Universitaria Policlinico Rodolico-San Marco, University of Catania, assessed 1,443 consecutive BAV patients treated with TAVR across 29 centers. Of these, 860 received BE-THVs, while 583 were treated with SE-THVs. Patients were followed for up to three years.
“These data suggest that both balloon-expandable and self-expanding THVs offer similar long-term safety and efficacy for BAV patients undergoing TAVR,” the authors noted, emphasizing that device selection should consider anatomical features and procedural risks rather than anticipated survival differences.
Bicuspid aortic valve anatomy poses unique challenges in TAVR due to asymmetric calcification and elliptical annuli, raising concerns about procedural complications. Despite these challenges, the findings underscore the progress in treating BAV with transcatheter approaches and the feasibility of both valve types for this patient population.
The authors concluded that while the choice between BE-THV and SE-THV does not affect major long-term outcomes like death or stroke, clinicians should weigh trade-offs in terms of procedural complications, including annular rupture risk with BE-THV and conduction disturbances with SE-THV.
"The study reinforces the need for individualized decision-making in BAV interventions and highlights the importance of continuous device innovation to optimize outcomes in this anatomically complex group," the authors concluded.
Giacoppo D, Alvarez-Covarrubias H, Xhepa E, et al. Transcatheter aortic valve replacement with balloon- versus self-expandable bioprostheses for the treatment of bicuspid aortic valve stenosis. Circulation. 2025;Epub ahead of print.
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