Bicuspid aortic valve type in predicting the occurrence of paravalvular leak following transcatheter aortic valve implantation

Q: What are the key findings of this study?

Right-left cusp fusion in bicuspid aortic valve stenosis was independently associated with a significantly increased risk of more than mild paravalvular leak following TAVI (OR 7.7).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Bicuspid aortic valve stenosis (n=145). Intervention: Right-left (R-L) cusp fusion bicuspid aortic valve vs. Other bicuspid aortic valve subtypes. Primary outcome: Occurrence of more than mild paravalvular leak (PVL) following TAVI (OR 7.7, 95% CI 1.34-44.4, p=0.02).

Małgorzata Nieznańska; Karina Zatorska; Maria Jaworska-Wilczyńska; Karolina Marzec; Marcin Grabowski; Ilona Kowalik; Patrycjusz Stokłosa; Zbigniew Chmielak; Adam Witkowski; Maciej Dąbrowski; T Hryniewiecki; Ilona Michałowska

doi:10.33963/v.phj.111778

March 25, 2026Kardiologia PolskaOpen Access

Bicuspid aortic valve type in predicting the occurrence of paravalvular leak following transcatheter aortic valve implantation

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Key result

Right-left cusp fusion linked to ~8-fold higher risk of significant post-TAVI paravalvular leak.

OR 7.7
95% CI 1.34-44.4
P=0.02
n=145

Why the study?

Do specific bicuspid aortic valve subtypes and aortic root morphologies predict the occurrence of more than mild paravalvular leak following TAVI?

Key Points

Assess whether bicuspid aortic valve (BAV) type and aortic root morphology predict the development and severity of paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI).
Retrospective single-center study analyzing 145 patients with BAV stenosis who underwent TAVI between January 2015 and December 2023.
BAV anatomy was classified by raphe presence into 2-sinus BAV, fused BAV (right-left, right-noncoronary, left-noncoronary), and two-raphe configurations.
Right-left (R-L) cusp fusion was associated with a higher incidence of more than mild PVL compared to other BAV types (38 [33.6%] vs. 3 [9.7%]; P = 0.007; adjusted OR, 4.48; 95% CI, 1.25–16.6; P = 0.02).
Patients with more than mild PVL exhibited higher calcium scores (4873 [3554–6514] vs. 3750 [2264–5900]; P = 0.03) and larger ascending aorta diameters (39.8 [4.9] mm vs. 37.9 [5.2] mm; P = 0.045) than those with mild or less PVL.
Multivariable analysis identified R-L cusp fusion (OR, 7.7; 95% CI, 1.34–44.4; P = 0.02), pre-TAVI atrial fibrillation (OR, 5.7; 95% CI, 1.8–18.2; P = 0.003), and STJ short axis (OR, 1.29; 95% CI, 1.11–1.50; P <0.001) as independent predictors of more than mild PVL, while balloon-expandable valves showed lower risk (OR, 0.040; 95% CI, 0.009–0.175; P <0.001).

Study Design

Type

Cohort (n=145)

Multicenter

No

Structured PICO

Do specific bicuspid aortic valve subtypes and aortic root morphologies predict the occurrence of more than mild paravalvular leak following TAVI?

P

Population

145 patients with high-gradient bicuspid aortic valve stenosis undergoing transcatheter aortic valve implantation, evaluated retrospectively for anatomical predictors of paravalvular leak.

E

Exposure

Transcatheter aortic valve implantation (TAVI) using balloon-expandable or self-expanding prostheses

O

Outcome

Occurrence of more than mild paravalvular leak (PVL) following TAVI, assessed by transthoracic echocardiography before hospital dischargesurrogate

Main Result

Odds Ratio: 7.7 (95% CI 1.34–44.4)

Absolute Event Rate: 33.6% vs 9.7%

p-value: p=0.02

In patients with bicuspid aortic stenosis undergoing TAVI, right-left cusp fusion, self-expanding prostheses, extended sinotubular junction dimensions, and pre-existing atrial fibrillation independently predict an increased risk of more than mild paravalvular leak.

Limitations

Retrospective, single-center study design
Device selection bias as prosthesis type was selected based on anatomical characteristics rather than randomized allocation
PVL assessment was part of routine clinical evaluation and was not centrally adjudicated
Small sample size and large disproportion in the incidence of PVL
Marked predominance of the R-L cusp fusion phenotype limits the robustness of subgroup analyses
Retrospective, single-center study
Device selection bias (prosthesis type selected based on anatomical characteristics rather than randomized allocation)
PVL assessment was part of routine clinical evaluation and was not centrally adjudicated, with no formal interobserver variability analysis
Marked predominance of the R-L cusp fusion phenotype compared with other BAV subtypes limiting subgroup analyses
Short follow-up

Implication

R-L cusp fusion may elevate PVL risk after TAVI in bicuspid stenosis; leaves open subtype-specific device strategies pending prospective validation.

Abstract

BACKGROUND: Limited information exists on the impact of bicuspid aortic valve (BAV) type on paravalvular leak (PVL) occurrence following transcatheter aortic valve implantation (TAVI). AIMS: This study aimed to assess whether BAV type and aortic root morphology can predict the development and severity of PVL post-TAVI. METHODS: We retrospectively analyzed 145 patients with BAV stenosis who underwent TAVI at our center from January 2015 to December 2023. BAVs were classified based on the presence of raphes: 2-sinus BAV, fused BAV (right-left, right-noncoronary, left-noncoronary), and two raphes. RESULTS: The mean age was 77.4 (7.7) years, with 47.6% being men. Right-left (R-L) cusp fusion was associated with an increased incidence of greater than mild PVL (P = 0.02). Patients with more than mild PVL exhibited higher calcium score (4873 [3554-6514] vs. 3750 [2264-5900]; P = 0.03) and larger dimensions in the ascending aorta (39.8 [4.9] mm vs. 37.9 [5.2] mm; P = 0.045), sinotubular junction (STJ) long axis (33.7 [5.2] mm vs. 31.7 [4.2] mm; P = 0.02), and sinus of Valsalva (34.4 [4.6] mm vs. 32.6 [4.1] mm; P = 0.03) compared to those with ≤ mild PVL. Multivariable analysis showed independent predictors of more than mild PVL as the use of self-expanding prosthesis (P <0.001), STJ dimension (P <0.001), atrial fibrillation prior to TAVI (P = 0.003), and R-L cusp fusion (P = 0.02). CONCLUSIONS: The incidence of more than mild PVL varied with BAV subtypes and aortic root morphology. Independent factors increasing PVL risk included R-L cusp fusion, self-expanding prosthesis use, extended STJ short axis, and pre-existing atrial fibrillation.

Discussion

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Cite This Study

Nieznańska et al. (2026) conducted a cohort in Bicuspid aortic valve stenosis (n=145). Right-left (R-L) cusp fusion bicuspid aortic valve vs. Other bicuspid aortic valve subtypes was evaluated on Occurrence of more than mild paravalvular leak (PVL) following TAVI (OR 7.7, 95% CI 1.34-44.4, p=0.02). Right-left cusp fusion in bicuspid aortic valve stenosis was independently associated with a significantly increased risk of more than mild paravalvular leak following TAVI (OR 7.7).

synapsesocial.com/papers/69ca1280883daed6ee094f49 https://doi.org/10.33963/v.phj.111778

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Bicuspid aortic valve type in predicting the occurrence of paravalvular leak following transcatheter aortic valve implantation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Bicuspid aortic valve type in predicting the occurrence of paravalvular leak following transcatheter aortic valve implantation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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