Supra-Annular Self-Expanding Versus Intra-Annular Balloon-Expandable Transcatheter Aortic Valve Implantation: A Meta-Analysis of Valve-Related Outcomes

Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. The two most widely used platforms are either balloon-expandable intra-annular valve (BEV, Edwards) or self-expanding supra-annular valve (SEV) from Medtronic. Comparative data related to clinical and sub-clinical valve thrombosis are limited. The aim of this study-level meta-analysis is to evaluate its incidence and whether this translates into any difference in clinical outcomes. Methods: Electronic databases were searched from inception through to October 2025 to identify randomised clinical trials of patients receiving either platform. Rates of clinical and subclinical valve thrombosis were identified and compared between the two groups. Results: = 0.006]. This difference was not translated into increased risk of stroke, valve re-intervention, or death. Conclusion: Patients undergoing TAVI using SEV compared to BEV have a lower risk of clinical and sub-clinical valve thrombosis in randomized trials, which is largely influenced by small annulus anatomy. Larger studies with longer term follow-up or using a dedicated imaging protocol may provide better insights into the clinical sequelae of this phenomenon.