Compared with tricuspid aortic valves (TAV) and bicuspid aortic valves type 1 (BAV-1; 1 raphe), BAV type 0 (BAV-0; no raphe) was associated with a better long-term prognosis among patients with severe aortic stenosis (AS) undergoing TAVR procedures, according to a study published July 23 in JACC: Cardiovascular Interventions.

Weiya Li, MD, et al., looked at 2,553 patients with severe AS who underwent TAVR procedures (134 BAV-0, 305 BAV-1, and 2,114 TAV) at three large, high-volume heart centers in Denmark, China and Germany. Patients had a mean age of 80 ± 7 years and a median Society of Thoracic Surgeons score of 4% [Q1-Q3: 2%-5%].

Results showed at five-year follow-up, 1,720 participants (67%) were evaluated, and BAV-1 (adjusted HR: 2 [95% CI: 1-4]; p=0.004) and TAV (adjusted HR: 3 [95% CI: 2-5]; p<0.001) had a higher risk for the primary endpoint of all-cause mortality after TAVR compared with BAV-0.

BAV patients who were treated with balloon-expandable valves had a higher long-term all-cause mortality (42% [29%-52%] vs. 24% [18%-29%]; HR: 2 [95% CI: 1-3]; p=0.028) compared with patients who had self-expanding valves. The authors note that there were 14, 81 and 760 patients who died in the BAV-0, BAV-1 and TAV groups, respectively.

"Given its superior clinical outcomes, BAV-0 may be an ideal target for these investigations," write the authors. "…This approach is crucial for expanding the application scope of TAVR further and enhancing its benefits for a broader range of BAV patients."

"This study refines our understanding of TAVR in bicuspid anatomy; it reframes the conversation," writes Giuseppe Tarantini, MD, PhD, in an accompanying editorial comment. "As TAVR expands to younger, lower risk patients, precision is imperative. BAV-0 may prove not just appropriate but ideal."