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John Webb, David Wood, Janarthanan Sathananthan, Uri Landes, Balloon-expandable or self-expandable transcatheter heart valves. Which are best?, European Heart Journal, Volume 41, Issue 20, 21 May 2020, Pages 1900–1902, https://doi.org/10.1093/eurheartj/ehaa167
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This editorial refers to ‘Comparison of newer generation self-expandable vs. balloon-expandable valves in transcatheter aortic valve implantation: the randomized SOLVE-TAVI trial’†, by H. Thiele et al., on page 1890.
So, which are best? Balloon-expandable or self-expandable valves?
The prototypic balloon-expandable Sapien-type valves look very similar to their imitators, although the materials, build, and delivery systems may differ dramatically. Similarly, the prototypic self-expanding CoreValve family of valves feature supracoronary fixation and supra-annular valve function, amongst other features that may be much more important than the mere mechanism of expansion. Other self-expanding valves (e.g. Jenavalve, Portico, Centera, Acurate, Allegra, Venus, and Vitaflow) differ dramatically in appearance and function. Amongst many differences, some do not utilize supracoronary fixation and many do not feature supra-annular leaflets. The point being that comparisons of ‘self-expandable’ vs. ‘balloon-expandable’ valves are becoming increasingly nuanced. Each valve design will need to stand scrutiny on its own.
To date, the majority of randomized controlled trials have focused on the comparison of transcatheter aortic valve implantation (TAVI) with medical or surgical therapy. TAVI has now been shown to have outcomes competitive with surgery, irrespective of surgical risk. The focus may now shift to assessing differences, if any, between different transcatheter heart valve designs. The largest randomized comparison of balloon- and self-expandable valves to date (SCOPE1) compared the Sapien 3 and Acurate neo valve, with the Sapien 3 demonstrating superior results.1 However, few would conclude that this is proof that balloon-expandable valves are better. To a larger degree, each valve must stand on its own. It may be more helpful to focus on the current Sapien-type and CoreValve-type platforms.
