Patients with a bicuspid aortic valve (BAV) undergoing TAVR have similar 30-day and one-year mortality and stroke rates as patients with a tricuspid aortic valve, according to a study published May 27 in JACC: Cardiovascular Interventions.

John K. Forrest, MD, FACC, et al., used data from the STS/ACC TVT Registry to compare outcomes of patients with bicuspid valves vs. tricuspid valves undergoing TAVR with the self-expanding Evolut R or Evolut PRO valve. The study consisted of 932 patients with bicuspid valves and 26,154 patients with tricuspid valves. The researchers performed propensity matching to create 929 matched pairs for analysis. All patients were at increased surgical risk based on age or conditions like diabetes, prior surgery, stroke or peripheral vascular disease. The majority of bicuspid patients were at intermediate or high surgical risk.

After propensity matching, there were no significant differences in baseline characteristics between the two groups. At 30 days, the all-cause mortality rates were 2.6% in the bicuspid group vs. 1.7% in the tricuspid group. The one-year mortality rates were 10.4% and 12.1% for the bicuspid and tricuspid groups, respectively. Stoke rates were also similar for both groups at 30 days (3.4% for bicuspid patients vs. 2.7% for tricuspid patients) and one year (3.9% for bicuspid patients vs. 4.4% for tricuspid patients).

In addition, there were no significant differences between the two groups for in-hospital events, including mortality, stroke, coronary obstruction, pacemaker implantations, vascular complications or length of stay. Patients with bicuspid valves were more likely than those with tricuspid valves to require aortic valve reintervention at 30 days (0.8% vs. 0.1%) and at one year (1.7% vs. 0.3%).

According to the researchers, the study demonstrates that patients with bicuspid valves undergoing TAVR have similar 30-day and one-year mortality and stroke rates and quality of life improvement as those with tricuspid valves. Randomized trials looking at TAVR in low-risk patients with bicuspid valves are needed, the researchers note.

“This study suggests TAVR is a viable option for patients with bicuspid valve disease who are at increased surgical risk. It will be very important to continue to monitor these patients to see how the valves perform in 10 or 15 years,” says Forrest.

The study “further expands our knowledge about clinical and echocardiographic outcomes post-TAVR in BAV with a self-expanding platform,” Didier Tchetche, MD, and Saifullah Siddiqui, MD, write in an accompanying editorial comment. “However, there remain questions that need to be answered with our collective effort and exploration of this exciting, expanding field,” they conclude.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound

Keywords: Aortic Valve, Mitral Valve, Tricuspid Valve, Transcatheter Aortic Valve Replacement, Bicuspid, Heart Valve Diseases, Aorta, Stroke, Registries, Echocardiography, Pacemaker, Artificial, National Cardiovascular Data Registries, STS/ACC TVT Registry

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