Courtesy of Dr. Juan Manuel Pérez.
Bicuspid aortic valves (BAV), present in 0,5 to 2% of the population, represent a technical challenge in TAVR given the asymmetric nature of leaflets and frequent dilation of the ascending aorta, factors that might lead to different outcomes vs tricuspid aortic valves (TAV). This study sought to assess and compare in-hospital complications following TAVR in BAV vs TAV patients, in addition to identifying the associated risk factors.
The primary outcome was in-hospital complications: acute kidney failure (AKI), need for prmanent pacemaker implantation (PPM), paravalvular leak and device success, according to VARC-3 criteria. The secondary end point was identifying clinical and biochemical predictors of each of the complications.
The study retrospectively looked at 1154 patients undergoing TAVR at the West China Hospital between 2010 and 2022: 508 with BAV and 646 with TAV. Mean patient age was 71.9, and they were predominantly men (60%).
BAV patients were younger (70.3 vs. 72.1; p<0.001), presented lower proportion of NYHA III–IV (81.7% vs. 92.6%; p<0.001) and lower prevalence of hypertension (41.9% vs. 58.7%; p<0.001), though with higher prevalence of diabetes (20.9% vs. 15.3%; p=0.018). The study did not report on the proportion of self-expanding vs. balloon expandable valves.
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There were 40 AKI cases (11 with BAV and 29 with TAV; OR 0.52; CI95% 0.23–1.09), 134 PPM implantations (67 in each group; OR 1.29; CI95% 0.87–1.92), 129 paravalvular leaks (43 with BAV and 86 with TAV; OR 1.29; CI95% 0.82–2.02) and 1105 device success cases (492 with BAV and 613 with TAV; OR 1.65; CI95% 0.86–3.29). After adjusting for multivariables, no complication showed statistically significant differences according to valve type.
Additional analysis identified elevated total bilirubin and hypoalbuminemia were associated to higher risk of AKI; age, albumin and NYHA class were associated with need for PPM; platelet count with the occurrence of paravalvular leak; and leucocyte count with lower probability of device success.
Conclusion
In this retrospective cohort with over 1100 patients, in-hospital complications rate after TAVR did not differ significantly between BAV and TAV patients.
Original Title: Comparison of in-Hospital Complication Rates After Transcatheter Aortic Valve Replacement in Patients With Bicuspid Versus Tricuspid Aortic Valves: A Retrospective Cohort Study.
Reference: Tingxi Zhu, et al. Catheterization and Cardiovascular Interventions, 2025; 1–9.
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, presente en 0,5–2% de la población, representa un desafío técnico para el TAVR debido a la asimetría de sus valvas y a la frecuente dilatación de la aorta ascendente, factores que podrían condicionar resultados distintos en comparación con la válvula tricúspide (TAV).){kind=link}