Differences in Severity and Prognosis Between Bicuspid and Tricuspid Severe Aortic Stenosis

Q: What are the key findings of this study?

Bicuspid aortic valve was associated with a significantly lower 5-year all-cause mortality compared to tricuspid aortic valve in patients with severe aortic stenosis (HR 0.46).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe Aortic Stenosis (n=3815). Intervention: Bicuspid aortic valve (BAV) vs. Tricuspid aortic valve (TAV). Primary outcome: All-cause mortality at 5 years (HR 0.46, 95% CI 0.28-0.77, p=0.003).

Q: What does this research mean for the field?

In patients with severe aortic stenosis, bicuspid aortic valve is associated with significantly lower 5-year all-cause mortality compared with tricuspid aortic valve. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Taiji Okada; Takeshi Kitai; Takeshi Morimoto; Chisato Miyakoshi; Tomohiko Taniguchi; Mitsuhiko Ota; Takao Kato; Kenji Andò; Nobuhisa Ohno; Norio Kanamori; Koichiro Murata; Yuichi Kawase; Tatsuhiko Komiya; Makoto Miyake; Yoshio Arai; Chisato Izumi; Tadaaki Koyama; Yutaka Furukawa; Takeshi Kimura

doi:10.1016/j.jacadv.2025.102285

Key result

Bicuspid aortic valve linked to ~54% lower all-cause mortality versus tricuspid valve in severe AS.

HR 0.46
95% CI 0.28-0.77
P=0.003
n=3,815

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY-NC-ND

Why the study?

Current AS severity assessment and treatment strategies do not differentiate between bicuspid and tricuspid aortic valve patients.

Does bicuspid aortic valve (BAV) compared to tricuspid aortic valve (TAV) affect echocardiographic severity grading and all-cause mortality in patients with severe aortic stenosis?

Study Design

Type

Cohort (n=3,815)

Multicenter

Yes

Structured PICO

Does bicuspid aortic valve (BAV) compared to tricuspid aortic valve (TAV) affect echocardiographic severity grading and all-cause mortality in patients with severe aortic stenosis?

P

Population

3,815 patients with severe aortic stenosis (AS) enrolled in the CURRENT AS registry

I

Intervention

Bicuspid aortic valve (BAV)

C

Comparator

Tricuspid aortic valve (TAV)

O

Outcome

All-cause mortalityhard clinical

Main Result

Effect estimate: HR 0.46 (95% CI 0.28-0.77)

Absolute Event Rate: 6.5% vs 45.9%

p-value: p=0.003

Limitations

Lacks detailed anatomical classification of BAV such as the presence of raphe or the portion of fused cusps
Echocardiographic measurements were performed locally without a central core laboratory
Most BAV diagnoses were made intraoperatively, limiting preoperative applicability
Study period largely preceded the availability of transcatheter AVR in Japan
Incomplete flow data, including missing stroke volume indices
Ascending aortic dimensions and morphology were not systematically evaluated

Implication

Patients with severe bicuspid aortic stenosis have distinct hemodynamic profiles and significantly lower 5-year all-cause mortality compared to those with tricuspid aortic stenosis.

Abstract

BACKGROUND: Bicuspid aortic valve (BAV) often leads to aortic stenosis (AS). However, current severity assessment and treatment strategies do not differentiate between BAV and tricuspid aortic valve (TAV) patients. OBJECTIVES: The purpose of this study was to investigate differences in echocardiographic indices used to evaluate disease severity and to compare long-term outcomes between BAV and TAV. METHODS: We performed a post hoc analysis of 3,815 patients with severe AS enrolled in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry. Echocardiographic parameters and clinical outcomes were compared between patients with BAV and those with TAV. The primary outcome was all-cause mortality. Sensitivity analyses included propensity-score matching and estimation of HRs for BAV relative to TAV. The median follow-up period was 36.9 months (IQR: 18.2-51.8). RESULTS: ; P = 0.288) compared to those with TAV. Discordant severity grading was less frequent in BAV than in TAV (34% vs 58%; P < 0.001). Linear regression indicated larger aortic valve area in BAV for equivalent maximal aortic jet velocity and mean pressure gradient values. Five-year all-cause mortality was lower in BAV than in TAV (6.5% vs 45.9%; P < 0.001), with matched-cohort analysis confirming a survival benefit (HR: 0.46; 95% CI: 0.28-0.77; P = 0.003). CONCLUSIONS: Patients with BAV have unique hemodynamic characteristics distinct from TAV. Tailored evaluation criteria for BAV patients may influence both prognosis and treatment strategies.

Discussion

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Cite This Study

Okada et al. (2025) conducted a cohort in Severe Aortic Stenosis (n=3,815). Bicuspid aortic valve (BAV) vs. Tricuspid aortic valve (TAV) was evaluated on All-cause mortality at 5 years (HR 0.46, 95% CI 0.28-0.77, p=0.003). Bicuspid aortic valve was associated with a significantly lower 5-year all-cause mortality compared to tricuspid aortic valve in patients with severe aortic stenosis (HR 0.46).

synapsesocial.com/papers/6a0faf249e54838161fd0cb0 https://doi.org/10.1016/j.jacadv.2025.102285

Topics

Echocardiography

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Differences in Severity and Prognosis Between Bicuspid and Tricuspid Severe Aortic Stenosis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Differences in Severity and Prognosis Between Bicuspid and Tricuspid Severe Aortic Stenosis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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