Transcatheter vs surgical aortic valve replacement for bicuspid aortic valve disease

Abstract Background Transcatheter aortic valve replacement (TAVR) has emerged as an acceptable and often preferred alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis. However, the mid‐ and long‐term efficacy of TAVR in patients with bicuspid aortic valves (BAVs) remains unclear. This study aims to compare the mid‐term outcomes of patients with BAV undergoing either procedure. Methods We retrospectively reviewed all patients who underwent AVR at our institution between 2011 and 2022. Of 278 patients identified, 217 underwent SAVR and 61 underwent TAVR. Propensity score matching was used to create comparable groups. Outcomes were compared using Kaplan–Meier survival analyses and chi‐square tests (α = 0.05). Sensitivity analyses using multiple calliper widths assessed the robustness of our findings. Results In both unmatched and propensity score‐matched cohorts, Kaplan–Meier survival analysis demonstrated a significant survival advantage for SAVR over TAVR. TAVR patients experienced significantly higher rates of combined post‐operative complications—including stroke/transient ischaemic attack, bleeding, and dialysis—and showed a trend towards increased pacemaker implantation. However, TAVR was associated with significantly shorter hospital stays. Notably, sensitivity analyses consistently favoured SAVR across all calliper widths. Similar findings were observed within the low‐risk subgroup. Conclusion Despite longer hospital stays, SAVR was associated with improved mid‐term survival and fewer complications compared with TAVR in patients with BAV. These differences were particularly pronounced in the low‐risk cohort. Our findings support the continued consideration of SAVR for patients with BAV who are suitable surgical candidates and underscore the need for comprehensive, multicentre prospective studies.