Abstract

ObjectivesTo compare the outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) for severe stenosis of bicuspid aortic valve (BAV).MethodsWe evaluated the early and mid-term outcome of patients with stenotic BAV who underwent SAVR or TAVR for aortic stenosis from the nationwide FinnValve registry.ResultsThe FinnValve registry included 6463 AS patients and 1023 (15.8%) of them had BAV. SAVR was performed in 920 patients and TAVR in 103 patients with BAV. In the overall series, device success after TAVR was comparable to SAVR (94.2% vs. 97.1%, p = 0.115). TAVR was associated with increased rate of mild-to-severe paravalvular regurgitation (PVR) (19.4% vs. 7.9%, p < 0.0001) and of moderate-to-severe PVR (2.9% vs. 0.7%, p = 0.053). When newer-generation TAVR devices were evaluated, mild-to-severe PVR (11.9% vs. 7.9%, p = 0.223) and moderate-to-severe PVR (0% vs. 0.7%, p = 1.000) were comparable to SAVR. Type 1 N-L and type 2 L-R/R-N were the BAV morphologies with higher incidence of mild-to-severe PVR (37.5% and 100%, adjusted for new-generation prostheses p = 0.025) compared to other types of BAVs. Among 75 propensity score-matched cohorts, 30-day mortality was 1.3% after TAVR and 5.3% after SAVR (p = 0.375), and 2-year mortality was 9.7% after TAVR and 18.7% after SAVR (p = 0.268)ConclusionsIn patients with stenotic BAV, TAVR seems to achieve early and mid-term results comparable to SAVR. Type 1 N-L and type 2 L-R/R-N BAV morphologies had higher incidence of PVR. Larger studies evaluating different phenotypes of BAV are needed to confirm these findings.Clinical trial registrationClinicalTrials.gov Identifier: NCT03385915.Graphic abstract

Highlights

  • Bicuspid aortic valve (BAV) is the most common congenital cardiac defect with a prevalence of 0.65% in the most recent autopsy series [1]

  • The proportion of transcatheter aortic valve replacement (TAVR) for stenotic BAV in each center ranged from 2.0% to 8.2%, and 80.6% of TAVR procedures for stenotic BAV were performed after 2014

  • In patients with stenotic BAV, 30-day and 2-year mortality as well as device success and paravalvular regurgitation (PVR) were comparable after TAVR and SAVR

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Summary

Introduction

Bicuspid aortic valve (BAV) is the most common congenital cardiac defect with a prevalence of 0.65% in the most recent autopsy series [1]. Recent randomized studies showed comparable outcomes in tricuspid AS after TAVR and SAVR even in low-risk patients [5, 6]. The increased risk of vascular complications, permanent pacemaker implantation and paravalvular regurgitation (PVR) after TAVR in BAV is a matter of concern [7, 8]. The risk of such complications seems to be reduced with the use of newer-generation TAVR devices [7, 9, 10], but current guidelines do not provide any advice regarding the routine use of TAVR in BAV patients [11, 12]. We sought to analyze the early and mid-term outcomes of these treatment methods in patients with BAV from a nationwide registry

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