Abstract 11088: Trend, Predictors and Outcomes of Transcatheter Aortic Valve Implantation in Patients with Bicuspid Aortic Valve; A National Inpatient Sample Database Analysis

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with bicuspid aortic valve (BAV) related to aortic stenosis (AS) with insufficient data on its safety and efficacy. Hypothesis: TAVI in BAV has worst outcomes. Methods: The National Inpatient Sample (NIS) database was queried to identify patients undergoing TAVI for BAV-AS. The major adverse cardiovascular events (MACE), its components [in-hospital mortality, stroke, subsequent myocardial infarction (MI)] and procedure related complications were assessed using a propensity-matched analysis (PSM) to calculate adjusted odds ratios (aOR). Results: A total of 435,841 TAVI crude and 10,743 matched population [trileaflet aortic valve (TAV) 5347, BAV 5396] was included in the final analysis. On PSM, the adjusted odds of cardiac tamponade (aOR 0.61, 95% CI 0.41-0.90), vascular complications (aOR 0.37, 95% CI 0.24-0.56) and stroke (aOR 0.81, 95% 0.65-1.02) were significantly lower in the BAV group, while there was no difference in the risk of in-hospital mortality, post-procedural myocardial infarction, major bleeding, acute kidney injury (AKI) and need for hemodialysis between the two groups. The yearly trend of in-hospital endpoints showed a steady decline in the overall annual rate of complications among those with BAV undergoing TAVI. Compared to early years, the odds of mortality, MI, need for PPM and IABP were identical between the two groups in 2016-2018. A stratified analysis based on age (<65 vs. >66 years), sex (male vs. female), history of coronary artery disease (CAD) and end-stage renal disease (ESRD) followed the net results. Conclusion: TAVI utilization in patients with BAV has increased remarkably over the recent years. The resultant risk of procedural complications such as in-hospital mortality, major bleeding and the overall rate of complications are comparable to those having TAV-AS.