Key result
Type 0 BAV is linked to ~82% fewer post-TAVI conduction abnormalities versus type 1.
Why the study?
BAV anatomy is heterogeneous, with variations that might differently influence the risk of conduction abnormalities in patients undergoing TAVI.
Does Sievers type 0 bicuspid aortic valve morphology reduce the risk of conduction abnormalities compared to type 1 in patients undergoing TAVI?
Cohort (n=115)
Does Sievers type 0 bicuspid aortic valve morphology reduce the risk of conduction abnormalities compared to type 1 in patients undergoing TAVI?
In patients with bicuspid aortic stenosis undergoing TAVI, Sievers type 0 morphology is associated with a significantly lower risk of 30-day conduction abnormalities compared to type 1 morphology.
Answers are grounded in this paper and cite their sources.
May inform bicuspid TAVI risk models; observational association leaves open prospective validation before practice change.
Background Bicuspid aortic valve (BAV) anatomy is highly heterogeneous with distinct anatomical variations that might differently influence the risk of conduction abnormalities (CA) in patients undergoing transcatheter aortic valve implantation (TAVI) Purpose We aimed to evaluate the impact of different BAV anatomy, specifically Sievers type 0 versus type I, on the incidence of CA in patients undergoing TAVI. Methods All consecutive patients with symptomatic severe bicuspid aortic stenosis (AS), who underwent computed tomography (CT) before TAVI between January 2015 and May 2024 were included. Patients were categorized based on Sievers BAV morphology into type 0 and non-type 0 (type 1A, IB, and IC). The primary outcome was the development of post-procedural CA defined as new left bundle branch block (LBBB), high-grade atrioventricular block (AVB), or permanent pacemaker implantation (PPI) within 30 days after TAVI. Results A total of 248 patients were CT-confirmed for BAV during the study period; 115 (46%) patients with a mean age of 75±8 years and a Society of Thoracic Surgeons score of 1.9±1.2%, underwent TAVI with contemporary devices. Type 0 morphology was identified in 17/115 patients (15%), and non-type 0 in 98/115 patients (85%). LBBB was observed in 10/115 (9%) and PPI was implanted in 19/115 (16%). Self-expanding valves were implanted in 8/17 (47%) patients with type 0 morphology compared to 37/98 (38%) with non-type 0 morphology (P = 0.46). CAs occurred in 1/17 (6%) with type 0 BAV compared to 28/98 (28%) patients with Type 1 BAV (P = 0.047). In a multivariate regression analysis adjusting for baseline right bundle branch block, implanted valve size, balloon-expandable devices, and membranous septum length, Type 0 BAV morphology emerged as an independent protective predictor for CA (OR: 0.118; 95% CI: 0.014–0.990; P = 0.049) Conclusions In bicuspid aortic stenosis, conduction abnormalities are influenced by valve morphology. Compared to Sievers type 1, type 0 BAV morphology was less frequently associated with conduction abnormalities in patients undergoing TAVI.
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Guz et al. (2025) conducted a cohort in Symptomatic severe bicuspid aortic stenosis (n=115). Sievers type 0 bicuspid aortic valve morphology vs. Sievers non-type 0 (type 1) bicuspid aortic valve morphology was evaluated on Development of post-procedural conduction abnormalities (new LBBB, high-grade AVB, or PPI) within 30 days after TAVI (OR 0.118, 95% CI 0.014-0.990, p=0.049). Sievers type 0 bicuspid aortic valve morphology was associated with fewer conduction abnormalities after TAVI compared to type 1 (6% vs 28%; OR 0.118; 95% CI 0.014-0.990; P=0.049).
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