Selecting the optimal valve type in bicuspid aortic stenosis remains a critical decision in TAVR. A large multicenter analysis of 1,443 patients, published in Circulation, compared outcomes with balloon-expandable (BE-THV) and self-expandable (SE-THV) devices across 29 centers.

At 30 days, death or stroke occurred in 5.1% of BE-THV and 6.1% of SE-THV recipients. At 3 years, outcomes remained similar at—23.7% vs. 26.2% (HR 0.99, 95% CI 0.65–1.51). While survival did not differ, complication profiles diverged. BE-THV was associated with annulus rupture and greater mean transvalvular gradients. SE-THV was more often linked to paravalvular regurgitation, additional valve implantation, and permanent pacemaker use (18.6% vs. 11.9%; HR 0.58, 95% CI 0.36–0.93).

The findings show that valve type does not influence long-term mortality in bicuspid TAVR, but distinct complication risks emphasize the importance of individualized device selection.