Aortic Valve Replacement vs Balloon-Expandable and Self-Expandable Transcatheter Implantation in Low-Risk Patients

Aims: this study sought to compare midterm outcomes of low-risk patients who underwent surgical aortic valve replacement (SAVR) vs balloon expandable (BE) or self-expandable (SE) TAVI. Methods: data of consecutive patients undergoing SAVR or transfemoral TAVI between 2017 and 2022 were collected. Patients were separated in 3 groups according to the type of prosthesis: biological surgical prosthesis, BE prosthesis and SE prosthesis. The 3 groups were compared in terms of baseline characteristics, post-procedural outcomes and long-term survival. Results: 542 patients were enrolled. 221 received a surgical prothesis, 150 received a BE prosthesis and 171 a SE prosthesis. TAVI patients were older and with a higher risk profile compared to surgical patients. Propensity score matching resulted in an excellent matching of nearly 80 patients in each group. In the matched cohort, SE prostheses were associated with a significantly higher incidence of stroke (SE group 6.3%, BE group 0, SAVR group 2.3%, p=0.045), para-valvular leak (SE group 8.1%, BE group 2.4%, SAVR group 0, p=0.017) and left bundle branch block (SE group 23.8%, BE group 18.2%, SAVR group 0 %, p< 0.001). Regarding 5-year mortality no significant differences were reported between BE and SE TAVI (13.6% vs22.5%, p=0.066). However, when comparing surgery versus TAVI, SE prosthesis showed a significantly higher 5-year mortality (22.5% vs 11.6%, p=0.042). Instead, BE prosthesis demonstrated their non inferiority compared to surgical prosthesis (13.6% vs 11.6%, p=0.249). Conclusion: BE prosthesis should be considered the prosthesis of choice for patients with long life-expectancy requiring a transcatheter procedure.