Key result
Self-expandable and balloon-expandable valves show similar mortality in bicuspid aortic stenosis.
Why the study?
Does the use of self-expandable transcatheter heart valves improve clinical outcomes (death, stroke) compared to balloon-expandable valves in patients with severe bicuspid aortic valve stenosis undergoing TAVR?
Cohort (n=92)
No
Does the use of self-expandable transcatheter heart valves improve clinical outcomes (death, stroke) compared to balloon-expandable valves in patients with severe bicuspid aortic valve stenosis undergoing TAVR?
TAVR for bicuspid aortic valve stenosis is feasible with both balloon- and self-expandable valves, achieving high technical success without significant difference in midterm mortality, but overall outcomes remain suboptimal.
Answers are grounded in this paper and cite their sources.
No mortality difference supports valve flexibility in bicuspid TAVR; extends observational data but leaves optimal selection open.
Background Outcomes >2 years after transcatheter aortic valve replacement (TAVR) for bicuspid aortic valves (BAV) are scarce, and differences between balloon‐expandable transcatheter heart valves (THVs) and self‐expandable (SE‐THVs) are not yet well established. Methods This study aims to report midterm outcomes after TAVR in patients with BAV and includes 92 patients undergoing TAVR for BAV stenosis at the University Hospital Cologne between 2018 and 2023. The primary outcomes were all‐cause death, cardiovascular death, and stroke over a mean follow‐up of 2.9 years. Results Among 92 consecutive patients undergoing TAVR for BAV stenosis (median age: 78.8 years), the incidence of all‐cause death, cardiovascular death, and stroke was 26.1%, 18.5%, and 14.1%, respectively, at 2.9 years, with no differences between balloon‐expandable THVs and SE‐THVs. Pacemaker implantation tended to be more frequent in the SE‐THV group. Periprocedural complications were rare, as reflected by a high Valve Academic Research Consortium‐3 technical success rate of 96.7%. Postprocedural transvalvular gradients were favorable, with SE‐THV showing lower values than balloon‐expandable THV (8.0 versus 10.5 mm Hg, P =0.007). Moderate or severe paravalvular regurgitation was uncommon, with no differences between groups, although a trend toward more relevant paravalvular regurgitation with SE‐THV was observed. Conclusions TAVR for BAV is feasible with both SE‐THV and balloon‐expandable ‐THV, achieving high technical success and low complication rates. Hemodynamic differences were observed, but mortality and stroke did not differ significantly between groups. Overall outcomes remain suboptimal, highlighting the need for randomized trials comparing valve types and TAVR with surgery for patients with BAV.
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Nienaber et al. (2026) conducted a cohort in Severe bicuspid aortic valve stenosis (n=92). Self-expandable transcatheter heart valves (SE-THVs) vs. Balloon-expandable transcatheter heart valves (BE-THVs) was evaluated on All-cause death at mean 2.9 years follow-up (Adjusted HR 0.93, 95% CI 0.35-2.45, p=0.885). In patients with severe bicuspid aortic valve stenosis, the use of self-expandable transcatheter heart valves did not significantly differ from balloon-expandable valves regarding all-cause mortality (adjusted HR 0.93).
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