Outcomes Following Transcatheter Aortic Valve Replacement for Aortic Stenosis in Patients With Type 0 Bicuspid, Type 1 Bicuspid, and Tricuspid Aortic Valves

Abstract

BACKGROUND: Data concerning the outcomes of transcatheter aortic valve replacement in type 0 bicuspid aortic stenosis (AS) are scarce. The study aims to compare the outcomes of transcatheter aortic valve replacement for AS in patients with type 0 bicuspid, type 1 bicuspid, and tricuspid aortic valve anatomy. METHODS: We enrolled consecutive patients undergoing transcatheter aortic valve replacement for severe AS between 2012 and 2022 in this single-center retrospective cohort study. The primary outcome was mortality, while secondary outcomes included in-hospital complications such as stroke and pacemaker implantation and transcatheter heart valve hemodynamic performance. RESULTS: The number of patients with AS with type 0 bicuspid, type 1 bicuspid, and tricuspid aortic valve anatomy was 328, 302, and 642, respectively. Self-expanding transcatheter heart valves were used in the majority of patients (n=1160; 91.4%). In the matched population, differences in mortality (30 days: 4.2% versus 1.7% versus 1.7%, P overall =0.522; 1 year: 10% versus 2.3% versus 6.2%, P overall =0.099) and all stroke (30 days: 1.0% versus 0.9% versus 0.0%, P overall =0.765; 1 year: 1.4% versus 1.6% versus 1.3%, P overall =NS) were nonsignificant, and the incidence of overall in-hospital complications was comparable among groups. Ascending aortic diameter was the single predictor of 1-year mortality in type 0 bicuspid patients (hazard ratio, 1.59 [95% CI, 1.03–2.44]; P =0.035). The proportion of patients with a mean residual gradient ≥20 mm Hg was the highest in those with type 0 bicuspid anatomy, although the need for permanent pacemaker implantation was the lowest in this group. CONCLUSIONS: Major clinical outcomes of transcatheter aortic valve replacement for AS in patients with type 0 bicuspid, type 1 bicuspid, and tricuspid aortic valve anatomy are equivalent at short- and mid-term follow-up. These observations merit further exploration in prospective international registries and randomized controlled trials.

Three‐year clinical outcomes after transcatheter aortic valve implantation in patients with bicuspid aortic disease: Comparison between self‐expanding and balloon‐expandable valves

“…In our retrospective analysis we reported good procedural and short‐term clinical outcomes, without significant differences in terms of periprocedural complications, 30‐days and 1‐year clinical outcomes between the two groups, confirming the previous results of the BEAT Registry 19 . He et al recently reported favorable short‐term clinical outcomes after TAVI, mainly using SEV (91.4%), in patients with BAV type 0 (25.8%) and type 1 (23.7%), without significant difference in terms of mortality and major complications as compared to matched TAV patients (50.5%) 22 . In our population the percentage of BAV type 0 was very low, so we cannot offer statement regarding this specific subgroup.…”

“…and type 1 (23.7%), without significant difference in terms of mortality and major complications as compared to matched TAV patients (50.5%). 22 In our population the percentage of BAV type 0 was very low, so we cannot offer statement regarding this specific subgroup. Overall, we observed similar rate of all-cause mortality (3.4% vs. 1.7%) and stroke (2% vs. 0.9%) at 30 days.…”

Transcatheter aortic valve replacement: A journey of two decades and beyond

“…Several propensity-matched studies, which diminish intrinsic baseline differences, have demonstrated equivalent 1-year mortality and incidence of moderate or severe PVL between bicuspid and tricuspid aortic valves using second-generation devices, as well as in low surgical risk patients. [ 12 ] However, current results are mainly derived from Sievers’ Type 1 bicuspid morphology, whereas the underpresented Type 0 subtype has recently been associated with a higher probability of elevated residual transvalvular gradients but a lower incidence of pacemaker implantation and PVL, [ 13 ] suggesting different behaviors among bicuspid subtypes.…”