Patient Outcomes of Self-expanding versus Balloon Expandable Transcatheter Valves in the Heavily Calcified Aortic Annulus

Objective: Aim of this study was to evaluate the performance of different transcatheter aortic valve prostheses in heavily calcified aortic annuli.

Methods: Between, January 2011 and May 2015, 1119 patients received transcatheter aortic valve implantations (TAVI) at our institution. 278 of these patients (age 81.8 ± 6.2 years, logistic EuroSCORE 24.2 ± 12.6%) were identified at multi-slice CT (MSCT) screening, of having a heavily calcified aortic annulus. This was defined as a calcium score of greater than the 75% (>3600 AU) on MSCT. 128 patients were treated with self-expanding and 150 patients with balloon expandable TAVI prostheses. Clinical endpoints were procedural complications, device success (VARC II) and 30 day all-cause mortality.

Results: 30 day mortality was comparable between the groups (self-expanding 6.3% versus balloon expandable 6.7%, p = 0.89). Residual aortic regurgitation > Grade II was higher in the self-expanding group (16.7% versus 4.7%, p = 0.0001). Procedural failure was also increased in the self-expanding group (25.8% versus 15.3%, p = 0.03). Other major complication rates like annular rupture (1.6% versus 1.3%, p = 0.87), stroke (2.3% versus 4%, p = 0.44), new onset pace maker implantation (12.5% versus 13.3%, p = 0.84) and conversion to conventional surgery (4.7% versus 3.3%, p = 0.56) were comparable between the groups.

Conclusion: TAVI in high risk surgical patients, with severely calcified aortic annuli, is feasible with both self-expanding and balloon expandable prosthesis. However, procedural complications and residual aortic regurgitation are lower when using balloon expandable prostheses.