Comparative outcomes of balloon-expandable versus self-expanding transcatheter aortic valves: insights from a large-scale German registry.
K, K., D, H., M, C., J, R., I, H., D, W., D, W., C, v.Z.M., & C, V. (2026). Comparative outcomes of balloon-expandable versus self-expanding transcatheter aortic valves: insights from a large-scale German registry.. BMC cardiovascular disorders. https://doi.org/10.1186/s12872-026-06462-9
K K, D H, M C, J R, I H, D W, et al. Comparative outcomes of balloon-expandable versus self-expanding transcatheter aortic valves: insights from a large-scale German registry.. BMC cardiovascular disorders. 2026; doi: 10.1186/s12872-026-06462-9
K K, D H, M C, et al. Comparative outcomes of balloon-expandable versus self-expanding transcatheter aortic valves: insights from a large-scale German registry.[J]. BMC cardiovascular disorders. 2026. DOI: 10.1186/s12872-026-06462-9.
@article{k2026,
author = {Kaier K and Hazard D and Czerny M and Rilinger J and Hilgendorf I and Wolf D and Westermann D and von Zur Mühlen C and Valina C},
title = {Comparative outcomes of balloon-expandable versus self-expanding transcatheter aortic valves: insights from a large-scale German registry.},
journal = {BMC cardiovascular disorders},
year = {2026},
doi = {10.1186/s12872-026-06462-9},
note = {PMID: 42613595},
}
TY - JOUR AU - Kaier K AU - Hazard D AU - Czerny M AU - Rilinger J AU - Hilgendorf I AU - Wolf D AU - Westermann D AU - von Zur Mühlen C AU - Valina C TI - Comparative outcomes of balloon-expandable versus self-expanding transcatheter aortic valves: insights from a large-scale German registry. T2 - BMC cardiovascular disorders PY - 2026 DO - 10.1186/s12872-026-06462-9 AN - PMID:42613595 ER -
BACKGROUND: While transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (SAVR), the comparative outcomes of balloon-expandable (BE) and self-expanding (SE) valve technologies remain an area of ongoing investigation. METHODS: Using the German DESTATIS database, we analyzed 48,565 transfemoral TAVR procedures performed between 2021 and 2022. Outcomes were compared between BE (n = 23,412) and SE (n = 25,153) valves using a double/debiased machine learning estimator to account for potential confounding. Key endpoints included in-hospital mortality, major bleeding, stroke, acute kidney injury, mechanical ventilation > 48 h, postoperative delirium, permanent pacemaker implantation (PPI), length of hospital stay, and reimbursement. RESULTS: Descriptively, SE valves were associated with significantly lower in-hospital mortality (1.6% vs. 2.0%, p < 0.001) and major bleeding (1.4% vs. 2.1%, p < 0.001) but a higher risk of stroke (2.4% vs. 1.9%, p < 0.001). A trend towards higher risk of PPI was observed (p = 0.078). After adjustment, patients with SE valves are at lower risk for in-hospital mortality (RR 0.85, p = 0.049) and major bleeding (RR 0.78, p = 0.006), but had a higher risk of stroke (RR 1.35, p < 0.001) and permanent pacemaker implantation (RR 1.09, p = 0.028). Subgroup analysis indicated that older and high-risk patients, particularly those aged ≥ 85 years, showed a stronger association with lower in-hospital mortality for SE valves, whereas younger patients exhibited a trend favouring BE valves. BE valves were also associated with a modestly higher reimbursement (€209 per case, p = 0.004). CONCLUSION: In this large, real-world cohort, self-expanding valves were associated with lower in-hospital mortality and major bleeding but a higher risk of stroke and permanent pacemaker implantation compared with balloon-expandable valves. Because prosthesis choice in routine practice is highly individualized and driven by anatomical and procedural factors not captured in administrative data, these associations are hypothesis-generating and cannot support device-selection recommendations.