Key result
Transcatheter aortic valve replacement was associated with similar all-cause mortality (4.8% vs 5.3%; OR 0.91, 95% CI 0.56-1.49) compared to surgical replacement in bicuspid aortic valve stenosis.
Why the study?
Large-scale studies comparing surgical aortic valve replacement and transcatheter aortic valve replacement in bicuspid aortic valve stenosis are lacking, and guidelines recommend TAVR only after careful evaluation.
Does TAVR improve all-cause mortality and stroke compared to SAVR in adult patients with bicuspid aortic valve stenosis?
Cohort (n=1,326)
Yes
Does TAVR improve all-cause mortality and stroke compared to SAVR in adult patients with bicuspid aortic valve stenosis?
In patients with bicuspid aortic valve stenosis, TAVR and SAVR demonstrate comparable mid-term rates of all-cause mortality and stroke, though TAVR is associated with higher pacemaker rates and lower short-term AKI and bleeding.
Background and Purpose Early pivotal transcatheter aortic valve replacement (TAVR) trials excluded patients with bicuspid aortic valve (BAV) stenosis. However, evidence suggests that TAVR in this population is associated with no difference in 30-day and 1-year mortality compared to trileaflet aortic valves1. Large-scale studies comparing surgical aortic valve replacement (SAVR) and TAVR in BAV stenosis are still lacking, and current guidelines recommend that TAVR may be considered as an alternative to SAVR only after careful evaluation2. Methods We conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Adult patients with BAV stenosis who underwent AVR between 1/2012 and 1/2022 were identified and divided into two groups based on whether they underwent TAVR or SAVR. Following a tight 1:1 propensity score matching for baseline demographics, prescribed medications, comorbidities, LVEF and baseline hemoglobin and serum creatinine, we calculated odds ratios and Cox proportional hazards ratios to compare outcomes over a two-year follow-up period. Primary outcomes included all-cause mortality and stroke. Secondary outcomes included permanent pacemaker (PPM) implantation, 30-day AKI, and procedure-related hemorrhage (with or without transfusion). Results The matched cohort included 1,326 patients with BAV who underwent AVR (n=663 per group; mean age: 65.9 years; 31% female; 89% White; mean LVEF: 56.9%). After a median follow-up of 21.6 months, all-cause mortality did not differ significantly between the two groups (TAVR: 4.8% vs. SAVR: 5.3%; OR: 0.91 [95% CI: 0.56–1.49]; P=0.71). The risk of stroke also did not differ significantly (TAVR: 12.1% vs. SAVR: 9.1%; OR: 1.379 [95% CI: 0.97–1.96]; P=0.074). PPM implantation was significantly more frequent in the TAVR group (11.8% vs. 8.1%; OR: 1.504 [95% CI: 1.04–2.17]; P=0.028). However, at 30 days, AKI and bleeding were less common following TAVR (OR: 0.376 [95% CI: 0.23–0.60]; P<0.0001 and OR: 0.23 [95% CI: 0.12–0.43]; P<0.0001, respectively). Time-to-event analysis of primary outcomes are depicted in Figure 1. Conclusions All-cause mortality and stroke rates are comparable between TAVR and SAVR in patients with BAV. However, TAVR is associated with an increased risk of PPM implantation, but a lower risk of short-term AKI and bleeding.
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Kassab et al. (2025) conducted a cohort in bicuspid aortic valve stenosis (n=1,326). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on all-cause mortality (OR 0.91, 95% CI 0.56-1.49, p=0.71). Transcatheter aortic valve replacement was associated with similar all-cause mortality (4.8% vs 5.3%; OR 0.91, 95% CI 0.56-1.49) compared to surgical replacement in bicuspid aortic valve stenosis.
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