Transcatheter aortic valve implantation in bicuspid aortic valves: insights from the German TAVI registry

Abstract

Background: Bicuspid aortic valves (BV) are considered a relative contraindication to transcatheter aortic valve implantation (TAVI). One of the main reasons is the presumed risk for paravalvular aortic regurgitation. However, case reports and small case series have suggested that TAVI can be successfully performed with acceptable clinical outcomes in high-risk patients with BV. Methods: Between 01/2009 and 06/2010 a total of 1424 patients with severe aortic stenosis undergoing TAVI were prospectively enrolled into the German TAVI-Registry. For the present analysis patients with valve-in-valve procedures were excluded and those with BV (n=38, 2.7%) were compared to those without BV (n=1357, 97.3%). Results: Patients characteristic did not markedly differ between the two groups (table). There was a strong tendency towards a higher rate of relevant aortic regurgitation after TAVI among patients with BV, whereas pacemakers were more often implanted in patients with tricuspid aortic valve. 30-day mortality was similar in both cohorts. In the Cox regression analysis BV was not associated with higher 1-year mortality (HR 0.64, 95%-CI 0.29-1.41). Conclusions: In selected patients with BV TAVI can be performed with a satisfactory clinical result. Although the risk for relevant aortic regurgitation seems to be higher among patients with BV, 1-year mortality is not elevated in comparison to patients with tricuspid aortic valves.