Long-Term Durability of Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis

Background: Transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) is increasingly performed in younger patients with long life expectancy. However, limited data exist on the durability of transcatheter heart valves (THVs). Aims: The aim of the present work is to compare the long-term durability of balloon-expandable (BEV) and self-expanding (SEV) THVs after TAVR. Methods: Electronic databases were searched up to May 2025 for studies reporting on the long-term durability of THVs in patients undergoing TAVR with a minimum follow-up of 5 years. Pooled odds ratios (ORs) with 95% confidence interval (CI) were used as summary statistics and were calculated using a random-effects model. Co-primary endpoints were moderate and severe structural valve deterioration (SVD) and the occurrence of all-cause bioprosthetic valve failure (BVF). All-cause death was the secondary endpoint. Results: A total of 22 studies and 12,131 patients undergoing TAVR were included: 52.5% of patients (n = 6362) received BEV, 47.5% (n = 5769) SEV. An old-generation THV was used in 84.5% of cases. At a median follow-up of 7 (5−8.3) years, the overall pooled estimates of moderate/severe SVD and BVF were 7% (5−9) and 4% (3−5), respectively. Patients treated with a BEV experienced a higher rate of SVD (OR: 2.09; 95% CI: 1.58−2.75; p < 0.001) and BVF (OR: 1.61; 95% CI: 1.10−2.36; p = 0.014); no difference was observed in terms of all-cause death. Conclusions: At long-term follow-up after TAVR, patients receiving a BEV experienced higher rates of moderate/severe SVD and of BVF compared to those having a SEV. However, no significant differences between the two THV designs were observed on the clinical endpoint of all-cause death.