Balloon- Versus Self-Expanding Transcatheter Valves for Failed Small Surgical Aortic Bioprostheses: 3-Year Results of the LYTEN Trial

In this article, the authors present the three-year results of the randomized LYTEN trial comparing balloon-expandable valves (BEV; SAPIEN 3/ULTRA) and self-expanding valves (SEV; Evolut R/PRO/PRO+) for valve-in-valve transcatheter aortic valve replacement (TAVR) in failed small surgical aortic bioprostheses (≤23 mm). Among 98 patients, SEV showed superior hemodynamic performance at three years, with lower mean gradients (13.1 ± 8.6 vs 20.4 ± 9.1 mm Hg), larger indexed effective orifice areas (0.93 ± 0.32 vs 0.69 ± 0.27 cm²/m²), and higher intended valve performance (82.4 percent vs 27.6 percent). Moderate aortic regurgitation was rare (2.9 percent SEV and 0 percent BEV). Functional status, quality of life, and the composite of death, stroke, or heart failure hospitalization were similar between the groups.