TAVR Safe in Patients With Bicuspid Aortic Valve: NCDR Late-Breaking Study

Patients with a bicuspid aortic valve who have stenosis have a similar rate of death following transcatheter aortic valve replacement (TAVR) as those with a tricuspid aortic valve, but have a higher likelihood of stroke, according to NCDR research presented March 17 at ACC.19 in New Orleans, LA.

Raj Makkar, MD, FACC, et al., analyzed data from the STS/ACC TVT Registry of more than 80,000 patients who underwent TAVR between 2015 and 2018. The researchers matched 2,691 patients who had a bicuspid valve with an equal number who had a tricuspid valve based on 25 variables and compared outcomes between the two groups. All patients were considered at intermediate or high risk for open-heart surgery.

For patients with bicuspid vs. tricuspid valves, respectively, there were similar rates for all-cause mortality rates at 30 days (2.6 percent vs. 2.4 percent) and one year (10.8 percent vs. 12.1 percent) post procedure.

There were no significant differences between the two groups in the functioning of the replacement valve. Patients with a bicuspid valve had a 50 percent higher risk of stroke at 30 days (2.4 percent, vs. 1.6 percent for tricuspid patients). Among patients with a bicuspid valve, 0.9 percent encountered problems during the TAVR procedure that required converting to open-heart surgery, compared with 0.4 percent of patients in the tricuspid group.

The researchers conclude that survival and stroke rates and valve function were similar in both groups but note that additional research is needed to determine why bicuspid valve patients were more likely to require conversion from TAVR to open-heart surgery.

Cardiology Magazine ImageKim A. Eagle, MD, MACC

In addition, the researchers note that a randomized trial would be needed to determine the risks and benefits of TAVR among younger, lower-risk patients with bicuspid aortic stenosis.

It is important to note patients with bicuspid valve and associated aortopathy may represent a particularly challenging group, comments ACC.org Editor-in-Chief Kim A. Eagle, MD, MACC.

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

Keywords: ACC19, ACC Annual Scientific Session, Transcatheter Aortic Valve Replacement, Aortic Valve, Aortic Valve Stenosis, Heart Valve Prosthesis, Heart Valve Diseases, National Cardiovascular Data Registries, STS/ACC TVT Registry

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