Courtesy of Dr. Carlos Fava.

Bicuspid aortic stenosis patients (bicuspid AS) represent a small group and have not been included in the larger transcatheter aortic valve replacement (TAVR) studies, since they present different morphology and asymmetric calcification, which might come along with more paravalvular leak and less accurate positioning.

Between 2012 and 2016, 475,315 patients undergoing TAVR or surgical aortic valve replacement (SAVR) were included in the National Inpatient Sample database. 31.895 of these patients presented bicuspid aortic stenosis and 1055 (10.4%) received TAVR; the rest received SAVR.

Those undergoing TAVR were older, more often were women, diabetic, hypertensive and more often presented cardiac failure, kidney function deterioration, stroke, peripheral vascular disease, and implantable cardioverter-defibrillator. Therefore, a propensity score match was carried out, leaving 975 patients in each group.

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In-hospital mortality was 3.1% in both groups. In addition, there were no differences between the strategies as regards cardiorespiratory arrest, cardiogenic shock, kidney function deterioration, stroke and the need for ventricular assistance. However, TAVR was associated to lower acute myocardial infarction rate (1% vs. 3.1% p=0.002), bleeding (23.6% vs. 44.6% p<0.001), transfusion (7.2% vs. 27.2% p<0.001), vascular complications (0.5% vs. 2.6% p<0.001), in-hospital stay (4 days vs. 7 days p<0.01), lower need for discharge to nursing facility (14.4% vs. 17.9% p=0.04) and lower respiratory assistance.

On the other hand, TAVR was associated with higher complete heart block (14.9% vs. 6.2% p<0.001) and need for definite pacemaker (13.8 vs. 4.6% p<0.001).

On the other hand, there were no differences in TAVR between bicuspids and tricuspids.

Conclusion

The National Inpatient Sample database showed similar mortality in severe bicuspid aortic stenosis patients undergoing TAVR or SAVR. Besides, TAVR presented similar mortality vs. tricuspid valves. further research is needed to assess long term evolution of TAVR in bicuspid aortic stenosis.

Courtesy of Dr. Carlos Fava.

Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis.

Reference: Ayman Elbadawi, et al. J Am Coll Cardiol Intv 2019;12:1811–22.

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