Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease
Key result
MSCT-based sizing for bicuspid TAVR links to an ~81% reduction in post-implantation AR.
- OR 0.19
- 95% CI 0.08 to 0.45
- P<0.0001
- n=139
Why the study?
Limited information exists describing the results and clinical outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valve disease.
Is transcatheter aortic valve replacement feasible and safe in patients with bicuspid aortic valve disease?
Population
139 patients undergoing TAV-in-BAV from 12 centers in Europe and Canada
Comparison
Balloon-expandable THV (n = 48) vs self-expandable THV (n = 91)
Design
Multicenter retrospective cohort study
Follow-up
1 year
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
JFJohn ForrestInterventional cardiologist, Yale University School of Medicine
“I do think we've developed a better understanding of aortic valve disease and anatomies that are conducive to transcatheter therapies, as well as anatomies not so conducive. What this study showed is that when you look at what's presently being done for patients with bicuspid aortic valve disease undergoing TAVR within the TVT registry, the outcomes are fairly similar to that of people who are getting TAVR for tricuspid aortic stenosis.”
“It may sound self-evident, but not all bicuspid valves are the same. Treatment strategy and procedural outcomes are dictated by anatomy. Although most patients referred for aortic valve replacement in 2025 expect transcatheter therapy, bicuspid aortic valves often present anatomic features that make TAVR more challenging or less predictable—for example, bulky leaflet or annular calcification, calcium extending into the left ventricular outflow tract, or marked annular eccentricity. In such cases, surgical aortic valve replacement remains the preferred option—assuming the patient is otherwise at low surgical risk.”
“The results are overall very encouraging. The procedural outcomes support that TAVR is safe in bicuspid patients.”
Implication
TAVR in bicuspid aortic valve should not yet change practice despite MSCT reducing AR; leaves open pending randomized confirmation.
Key Points
- The aim is to assess clinical outcomes for patients undergoing transcatheter aortic valve replacement in bicuspid aortic valve disease.
- Retrospective analysis from 12 centers in Europe and Canada
- Inclusion of 139 patients undergoing transcatheter aortic valve replacement
- Clinical follow-up findings analyzed for procedural data and outcomes
- Mean aortic gradient significantly decreased from 48.7 mm Hg to 11.4 mm Hg (p < 0.0001)
- Post-implantation aortic regurgitation grade ≥ 2 occurred in 28.4%; reduced with MSCT sizing (OR: 0.19, 95% CI: 0.08 to 0.45; p < 0.0001)
- One-year mortality rate was 17.5%, with major vascular complications linked to increased mortality (OR: 5.66, 95% CI: 1.21 to 26.43; p = 0.03)
Study Design
Type
Cohort (n=139)
Multicenter
Yes
Structured PICO
Is transcatheter aortic valve replacement feasible and safe in patients with bicuspid aortic valve disease?
P
Population
139 patients with bicuspid aortic valve (BAV) disease, mean age 78.0 ± 8.9 years, STS predicted risk of mortality score 4.9 ± 3.4%, from 12 centers in Europe and Canada.
I
Intervention
Transcatheter aortic valve replacement (TAVR) using balloon-expandable (n=48) or self-expandable (n=91) transcatheter heart valve systems.
O
Outcome
Clinical outcomes including procedural mortality, mean aortic gradient change, post-implantation aortic regurgitation (AR), 30-day device safety, success, and efficacy, and 1-year mortality.composite
Main Result
Effect estimate: OR 0.19 (95% CI 0.08 to 0.45)
p-value: p=<0.0001
TAVR is feasible in patients with bicuspid aortic valve disease but carries a high risk of post-implantation aortic regurgitation, which can be significantly mitigated by using MSCT-based valve sizing.
Limitations
- Suboptimal echocardiographic results
- Lack of long-term efficacy data
- Suboptimal echocardiographic results requiring further study to evaluate long-term efficacy
- Retrospective design
Cite This Study
Mylotte et al. (2014) conducted a cohort in Bicuspid aortic valve (BAV) disease (n=139). Transcatheter aortic valve replacement (TAV) was evaluated on Post-implantation aortic regurgitation (AR) grade ≥ 2 (OR 0.19, 95% CI 0.08 to 0.45, p=<0.0001). Transcatheter aortic valve replacement in bicuspid aortic valve disease is feasible, and MSCT-based sizing reduced post-implantation aortic regurgitation (OR 0.19; 95% CI 0.08-0.45).