Key result
Bicuspid TAVR linked to ~23% higher 30-day mortality versus tricuspid valves.
Why the study?
Although TAVR is considered the treatment of choice for symptomatic AS across all risk spectra, comparative outcomes between BAV and TAV patients require evaluation.
Does TAVR result in comparable clinical outcomes in patients with bicuspid aortic valves compared to tricuspid aortic valves?
Meta-Analysis (n=203,288)
Does TAVR result in comparable clinical outcomes in patients with bicuspid aortic valves compared to tricuspid aortic valves?
Effect estimate: OR 1.23 (95% CI 1.00-1.50)
p-value: p=0.05
TAVR in bicuspid aortic valves is associated with slightly higher early mortality, stroke, pacemaker implantation, and aortic regurgitation compared to tricuspid valves, though newer generation valves may improve 1-year survival.
Higher early mortality with TAVR in bicuspid valves warrants caution; leaves open whether newer devices close the gap versus tricuspid valves.
BACKGROUND: Bicuspid aortic valve (BAV) is present in approximately 0.5%-2% of the general population, causing significant aortic stenosis (AS) in 12%-37% of affected individuals. Transcatheter aortic valve replacement (TAVR) is being considered the treatment of choice in patients with symptomatic AS across all risk spectra. AIM: Aim Our study aims to compare TAVR outcomes in patients with BAV versus tricuspid aortic valves (TAV). METHODS: A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane trials. Studies were included if they included BAV and TAV patients undergoing TAVR with quantitative data available for at least one of our predefined outcomes. Meta-analysis was performed by the random-effects model using Stata software. RESULTS: Fifty studies of 203,288 patients were included. BAV patients had increased 30-day all-cause mortality (odds ratio [OR] = 1.23 [1.00-1.50], p = 0.05), in-hospital stroke (OR = 1.39 [1.01-1.93], p = 0.05), in-hospital and 30-day PPI (OR = 1.13 [1.00-1.27], p = 0.04; OR = 1.16 [1.04-1.13], p = 0.01) and in-hospital, 30-day and 1-year aortic regurgitation (AR) (OR = 1.48 [1.19-1.83], p < 0.01; OR = 1.79 [1.26-2.52], p < 0.01; OR = 1.64 [1.03-2.60], p = 0.04). Subgroup analysis on new-generation valves showed a reduced 1-year all-cause mortality (OR = 0.86 [CI = 0.75-0.98], p = 0.03), despite higher in-hospital and 30-day PPI (OR = 0.1.21 [1.04-1.41], p = 0.01; OR = 1.17 [1.05-1.31], p = 0.01) and in-hospital AR (OR = 1.62 [1.14-2.31], p = 0.01) in the BAV group. The quality of included studies was moderate-to-high, and only three analyses presented high heterogeneity. CONCLUSION: TAVR is associated with comparable outcomes in patients with BAV and TAV. Careful selection of BAV cases by preprocedural assessment of valve anatomy and burden of calcification, pre- and post-procedural dilation, and implementing newer generations of valves may improve the safety and efficacy of TAVR in BAV patients.
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Gupta et al. (2023) conducted a meta-analysis in Aortic stenosis (n=203,288). Transcatheter aortic valve replacement (TAVR) in bicuspid aortic valves (BAV) vs. TAVR in tricuspid aortic valves (TAV) was evaluated on 30-day all-cause mortality (OR 1.23, 95% CI 1.00-1.50, p=0.05). TAVR in patients with bicuspid aortic valves was associated with increased 30-day all-cause mortality compared to tricuspid valves (OR 1.23; 95% CI 1.00-1.50; p=0.05).
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