Severe aortic stenosis due to a bicuspid aortic valve (BAV) is uncommon, especially in individuals under 65 years of age. While there are usually no significant differences according to the type of valve when it comes to surgery, with transcatheter aortic valve replacement (TAVR) some may arise.
TAVR has seen significant advancements in the treatment of this disease. In some registries, its progression resembles that of tricuspid aortic valves (TAV). However, whether the different types of BAV have a similar evolution remains uncertain.
Researchers conducted an analysis on 1319 consecutive patients who underwent TAVR, of which 642 had TAV, 328 had BAV Type 0, and 302 had BAV Type I.
The primary endpoint (PE) assessed was all-cause death and stroke at 30 days and one year.
Given the differences between the populations, propensity score matching was applied, resulting in 121 patients in each group.
The average age was 73 years; 62% of patients were men, the STS score was 5.1%, 19% of subjects had diabetes, 45% of patients had chronic obstructive pulmonary disease (COPD), 34% had coronary artery disease, 18% had a history of stroke, and 15% had atrial fibrillation.
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In most cases, self-expanding valves were implanted. Hospital complications were similar between the groups.
There were no significant differences in the PE between the groups (6% vs. 2% vs. 2% for BAV Type 0, Type I, and TAV).
The 30-day mortality rates were 4.2% vs. 1.7% vs. 1.7%, respectively, and the 1-year mortality rates were 10% vs. 2.3% vs. 6.2%. The incidence of stroke was 1% vs. 0.9% vs. 0% at 30 days and 1.4% vs. 1.6% vs. 1.3% at one year.
The presence of a mean gradient ≥20 mmHg was more frequent in the BAV Type 0 group.
Conclusion
Major clinical events after TAVR in aortic stenosis patients with bicuspid aortic valve Type 0, Type I, and tricuspid aortic valve were equivalent in the short and medium term during follow-up. These observations suggest the need for future research in international prospective registries or randomized studies.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Reference: Jingjing He, et al. Circ Cardiovasc Interv. 2023;16:e013083. DOI: 10.1161/CIRCINTERVENTIONS.123.013083.
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