Outcomes of transcatheter aortic valve replacement in bicuspid versus tricuspid aortic stenosis with severe calcification

Background The comparative outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid versus tricuspid aortic stenosis (AS) with severe calcification remain unclear. This study aimed to compare the safety and efficacy of TAVR in these patient groups. Methods Using data from the Chinese Cardiovascular Association Database—National Transcatheter Valve Therapeutics Registry, we analysed 870 propensity score matched pairs of patients with severe calcification (≥470 mm³) undergoing TAVR between April 2014 and August 2023. Primary outcome was all-cause mortality at 1 year. Results No significant differences were observed in technical success (95.1% vs 94.7%), procedural complications or in-hospital outcomes. All-cause mortality at 1 year was similar between bicuspid and tricuspid AS (4.3% vs 5.3%, HR 0.87; log-rank p=0.62). The incidence of stroke (1.5% vs 1.4%), cardiovascular hospitalisation (1.4% vs 1.7%) and moderate-to-severe paravalvular leak (3.5% vs 2.5%) was similar during follow-up. The rate of new permanent pacemaker implantation was higher in bicuspid AS (8.4% vs 5.6%; p=0.03). Conclusions TAVR was observed to be equally safe and effective in bicuspid and tricuspid AS with severe calcification, though bicuspid AS was associated with a higher rate of permanent pacemaker implantation.