Temporal Trends and Outcomes of TAVR in Bicuspids: Are We Any Better?

This large registry has shown bicuspid aortic stenosis (AS) patients have similar mortality with transcatheter aortic valve replacement (TAVR) compared against surgical valve replacement (SAVR). TAVR outcomes in this population are not only similar to SAVR outcomes, but also to TAVR outcomes in patients with conventional aortic valve anatomy. Despite the good news, these outcomes are very short term, and we still ignore how these patients will evolve in the long run. 

The aim of this study was to find out the current TAVR trends in bicuspids, since there has been great advances in these devices and implantation technique, and to compare these outcomes with SAVR outcomes in a similar population. 

The data base of a whole country between 2012 and 2016 identified 31895 patients with severe AS and bicuspid anatomy receiving valve replacement. 1055 (3.3%) of these patients received TAVR, and propensity score was used to compare SAVR vs TAVR in bicuspids, and TAVR in bicuspids vs. TAVR in tricuspids. 

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Even though the proportion of patients undergoing TAVR was initially small, the number increased significantly over time. 

After propensity score, in-hospital mortality resulted similar between TAVR and SVAR (3.1% vs. 3.1%; OR: 1.00; CI 95%: 0.60 to 1.67).

Neither were there differences between TAVR and SAVR in terms of kidney injury, cardiac tamponade or stroke.

TAVR was associated to lower rates of MI, periprocedural bleeding, vascular complications, discharge to nursing facility, and shorter hospital stay. TAVR was also associated to higher incidence of complete heart block and permanent pacemaker implantation. 

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Mortality in patients receiving TAVR was similar among bicuspid and tricuspid patients. 

For now, this is the best information we have for patients with bicuspid valves, since there are no randomize studies yet. 

Conclusion

This large analysis showed similar mortality for patients with bicuspid valves undergoing TAVR vs. SAVR. WE need randomized studies on this specific population, with longer follow-up. 

Original title: 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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