Patients with bicuspid aortic valves (BAVs) undergoing TAVR may require aggressive stroke prevention strategies, according to a research letter published May 14 in JACC: Cardiovascular Interventions during the SCAI 2020 Scientific Sessions Virtual Conference.

Samir R. Kapadia, MD, FACC, assessed the impact of TAVR hospital case volumes on outcomes among patients with BAVs. The researchers studied 1,626 patients with BAVs who underwent TAVR between 2012 and 2017 at low-volume hospitals (performing ≤100 procedures annually) and high-volume hospitals (performing >100 procedures annually).

Among all patients, 53.1% underwent the procedure at a high-volume hospital. Patients with BAVs accounted for 0.9% of TAVR procedures at low-volume facilities and 1% at high-volume hospitals. Patients at high-volume centers were a median of 68 years vs. 64 years for patients at low-volume hospitals. Patients at high-volume hospitals also were more likely than those at low-volume hospitals to have heart failure (73% vs. 54.5%), renal failure (30.9% vs. 28.7%), tobacco use (45.8% vs. 36.6%), diabetes (29.2% vs. 23.3%), and prior myocardial infarction (12.7% vs. 5.6%).

Rates of in-hospital stroke were 3.6% and 1.8% at high- and low-volume facilities, respectively. In-hospital mortality was 2.3% at high-volume sites vs. 3.8% at low-volume sites. After adjusting for age, sex, comorbidities and CHA2DS2-VASc scores, there was no association with different rates of in-hospital stroke (odds ratio, 1.519; 95% confidence interval [CI]: 0.775-2.976; p=0.223) or mortality (odds ratio, 0.689; 95% CI, 0.368-1.290; p= 244) at high-volume vs. low-volume hospitals.

According to the researchers, the study is the first to look at TAVR hospital volume and outcomes in patients with BAVs. The stroke rate among BAV patients following TAVR "remains a critical unresolved issue" at both low- and high-volume hospitals, the researcher write, adding that the study's stroke rate in the BAV population is higher than shown in patients with tricuspid aortic valves. The researchers conclude the study reflects "current practice" for patients with BAVs but that "aggressive stroke prevention strategies should be pursued" in this population.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Aortic Valve, Transcatheter Aortic Valve Replacement, Hospitals, High-Volume, Hospitals, Low-Volume, Hospital Mortality, Heart Valve Diseases, Aorta, Stroke, Tricuspid Valve, Heart Failure, Myocardial Infarction, Diabetes Mellitus

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