E-40 | Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement in Patients with Bicuspid Aortic Stenosis: A Propensity Score Matching Analysis

There is limited contemporary data around trends and outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in bicuspid aortic stenosis (AS).We aimed to assess trends and outcomes of TAVR vs SAVR in bicuspid AS. We queried the National Inpatient Sample database (2012 to 2020) to identify admissions with bicuspid AS who underwent isolated AVR, and generated propensity scores with a 1:1 ratio. Our primary outcome of interest was in-hospital mortality and secondary outcomes were in-hospital complications. A total of 76,540 hospitalizations for AVR in bicuspid AS patients were identified, of which 92.1% underwent SAVR and 7.9% underwent TAVR. From 2012-2020, an overall increase in the proportion of TAVR (1.1% to 20.6%) was observed. The TAVR group had a higher proportion of females (38.8% vs. 29.0%; p <0.001), were older (68.5 vs 56.4, p <0.001), and had more comorbidities and previous cardiovascular events. After matching, in-hospital mortality rates were similar (TAVR vs SAVR, 1.6% vs 1.3%; OR 1.228; 95% CI: 0.553 – 2.826; p = 0.629). While no differences were seen in acute MI, AKI, and stroke, the TAVR group had lower rates of respiratory complications (1.1% vs 3.3%), post-operative bleeding (4.2% vs 11.3%), transfusion (5.0% vs 17.2%), and vascular complications (0.2% vs 2.0%). In this analysis, in-hospital mortality for TAVR and SAVR in bicuspid AS were similar, with TAVR showing lower rates of several complications. These findings suggest that TAVR might be a safe alternative to SAVR for bicuspid AS.