The assumption of a uniform “class effect” across transcatheter aortic valve implantation (TAVI) devices is not supported by evidence, according to a network meta-analysis published in Circulation. Data from 11 randomized controlled trials, including 9,946 patients with follow-up ranging from 1 to 10 years, compared outcomes across TAVI platforms and SAVR.

TAVI with self-expanding valves demonstrated similar all-cause mortality (absolute risk difference [ARD], 31/1000; 95% CI −12 to 79) and cardiovascular mortality (ARD, −8/1000; 95% CI −39 to 28) compared with SAVR, with moderate-certainty evidence. In contrast, balloon-expandable and mechanically expandable valves were associated with higher all-cause mortality (balloon-expandable ARD 109/1000; mechanically expandable ARD 123/1000) and cardiovascular mortality (balloon-expandable ARD 58/1000; mechanically expandable ARD 105/1000).

Direct comparisons confirmed higher mortality with balloon-expandable and mechanically expandable platforms versus self-expanding valves (high-certainty evidence). Stroke risk was greater with balloon-expandable devices, while pacemaker implantation occurred more often with self-expanding valves.

These findings highlight that device selection has significant clinical implications, challenging current guideline assumptions of equivalent outcomes across TAVI platforms.