In bicuspid patients with aortic stenosis and low surgical risk, transcatheter aortic valve replacement (TAVR) with balloon expandable valve offers results comparable to normal anatomy results.
These data come from the TVT registry, presented at EuroPCR 2021 scientific sessions.
Stroke and death rates (inhospital, 30 days and one year) in bicuspid patients did not result different to tricuspid patient rates. Both groups of patients also obtained similar benefits in valve area, gradients, functional class, and quality of life.
These data show TAVR could be a reasonable option to treat patients with aortic stenosis, bicuspid anatomy and low surgical risk when carefully selected.
Even though TAVR has long been approved by the FDA for the whole risk spectrum, studies providing evidence to support this claim have systematically excluded bicuspid anatomy.
The authors of this study examined data of nearly 160,000 patients in the TVT registry undergoing TAVR with Sapien 3 or Sapien 3 ultra between 2015 and 2020.
Read also: EuroPCR 2021 | A New Meta-Analysis Challenges the ISCHEMIA Trial.
Among them, 4.4% had bicuspid anatomy, and finally 3.168 presented low surgical risk (STS <3%). These fewer over 3,000 patients were compared using propensity score to tricuspid patients.
Femoral access was used in 97% of both groups, but bicuspid patients less frequently received conscious sedation (57% vs 62%; p<0.001) and more often the largest device available (38% vs 30%; p<0.001).
Complications rate as conversion to conventional surgery, annulus rupture, need for bypass, aortic dissection, coronary obstruction or need for a second valve were low (<0.5%) in both groups.
Read also: EuroPCR 2021 | Ultrathin Struts Consolidate as Next DES Development.
Paravalvular leak moderate to severe tended to be larger among the bicuspid, which calls for further study.
There is no doubt followup should be longer and, ideally, we should carry out a specific randomized study on bicuspids before extending any recommendation for TAVR to low-risk patients and, in general, young patients who could clearly benefit from surgery.
Original Title: Outcomes of transcatheter aortic valve replacement for bicuspid aortic valve stenosis in the low-surgical risk population.
Reference: Makkar R et al. Presentado en el EuroPCR 2021.
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