17 April 2026
A recent study has found that patients requiring urgent heart valve replacement can achieve similar long‑term survival regardless of which of two commonly used valve types is chosen, according to a new study led by cardiologists at both Royal Brompton and Harefield hospitals.
This supports the premise that doctors can select the valve and procedural approach based on each patient’s individual anatomy and the clinicians experience, rather than concerns about long‑term survival outcomes.
This study, published in the International Journal of Cardiology, was led by Dr Vasileios Panoulas, consultant cardiologist, and Dr Anastasios Apostolos, cardiology clinical fellow .
The aortic valve is located between the left ventricle of the heart and the aorta, the major artery that carries blood from the heart to the rest of the body. When this valve does not function correctly it is referred to as aortic valve disease. The most common form of this disease is aortic stenosis (AS), a condition where the valve becomes narrowed and stiff reducing blood flow from the heart.
Patients who have AS often present with acute heart failure, an urgent condition where the heart cannot pump enough blood to meet the body’s needs. To restore blood flow from the heart, patients with aortic stenosis may require a procedure to repair or replace the aortic valve.
One effective treatment option is the transcatheter aortic valve implantation (TAVI), a minimally invasive procedure that replaces the diseased valve without the need for open heart surgery. Instead, doctors guide a narrow, flexible tube (called a catheter) through a blood vessel in the upper leg or chest and up to the heart, where it is used to position and deploy a new valve in place of the damaged one.
When TAVI is performed in a patient with acute heart failure, it is classed as an urgent procedure, rather than an elective (planned/non-emergency) procedure.
This study compared 2 types of transcatheter heart valve designs used during TAVI: self-expanding valves (SEV) and balloon-expandable valves (BEV). The key difference between these devices is how the replacement valve is implanted. SEVs opens up on their own once in positioned, while BEVs are expanded using a small balloon.
Previous clinical trials have demonstrated that both valves are similarly safe and effective when TAVI is carried out. However, there is a lack of research comparing these valves in urgent TAVI for patients with acute heart failure. This study aimed to address the gap by comparing outcomes for patient undergoing urgent TAVI using either SEV or BEV.
The study was a multicentre observational study and analysed patient data from both Royal Brompton Hospital and Harefield Hospital between January 2012 and December 2024. The study reviewed real-world clinical records, meaning some factors such as experience of the person operating, could not be fully controlled, though the analysis adjusted for these differences. Over the 12-year period, 3992 patients underwent TAVI at the 2 centres. Of these, 587 procedures were urgent, and 266 used BEV while 321 used SEV.
The main focus of the study was to assess the long-term survival in patients undergoing TAVI. The researchers also looked at multiple secondary outcomes such as device success, rates of major and minor bleeding and post procedure pacemaker implantation (PPI).
The study found no significant difference in long-term survival between patients receiving SEV or BEV during urgent TAVI. Most secondary outcomes were also similar between the 2 valve types, thereby supporting personalised valve selection based on patient anatomy and clinician preference.
According to the research team, this is the first to compare SEV with BEV in patients undergoing urgent TAVI.
When asked for comment Dr Apostolos stated:
“Urgent TAVI represents one of the most challenging scenarios in interventional cardiology, where we are required to make rapid, high-stakes decisions for critically unwell patients. Our findings are reassuring, as they suggest that both self-expanding and balloon-expandable valves offer comparable long-term survival in this setting, meaning clinicians can focus on selecting the valve that best suits the individual patient's anatomy and their own procedural expertise, rather than being driven by outcome-related concerns.
“This is the first study to directly address this clinical question, and we hope it provides a practical evidence base to guide decision-making in urgent TAVI. We are proud that this work reflects the depth of experience and the quality of data accumulated over more than a decade across both Royal Brompton and Harefield hospitals.”
The study abstract can be viewed here.
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