Key result
Bicuspid anatomy is not associated with increased 1-year MACCE risk after small-annulus TAVR.
Why the study?
Clinical outcomes and haemodynamic performance following TAVR had not been directly compared between severe bicuspid versus tricuspid aortic stenosis with small annuli.
Does transcatheter aortic valve replacement provide comparable clinical outcomes and haemodynamic performance in patients with bicuspid versus tricuspid aortic stenosis who have small aortic annuli?
Observational (n=427)
No
Does transcatheter aortic valve replacement provide comparable clinical outcomes and haemodynamic performance in patients with bicuspid versus tricuspid aortic stenosis who have small aortic annuli?
Hazard Ratio: 1.408 (95% CI 0.622–3.191)
Absolute Event Rate: 9.8% vs 14.5%
p-value: p=0.412
TAVR provides comparable clinical and haemodynamic outcomes at 1 year for selected patients with bicuspid versus tricuspid aortic stenosis who have small annuli, despite a higher rate of procedural technical failure in bicuspid anatomy.
May inform TAVR decisions in selected bicuspid small-annulus patients; leaves open need for randomized confirmation.
OBJECTIVE: To compare the clinical outcomes and haemodynamic performance following transcatheter aortic valve replacement (TAVR) in patients with severe bicuspid versus tricuspid aortic stenosis (AS) and small annuli. DESIGN: Retrospective analysis based on a prospective observational cohort. SETTING: Single-centre registry of patients undergoing TAVR between 2016 and 2023. PARTICIPANTS: (IQR 348.0-406.4)), all undergoing preprocedural multidetector CT and standardised follow-up echocardiography. MAIN OUTCOMES MEASURE: Baseline characteristics, technical success, procedural complications, haemodynamic performance and bioprosthetic-valve dysfunction (BVD) were compared between groups. The primary clinical outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality, stroke and rehospitalisation for heart failure.Cox regression was used to adjust for confounders. RESULTS: Compared with TAV patients, BAV recipients experienced higher technical failure rates (11.4% vs 6.0%, p=0.045) but lower permanent pacemaker implantation (4.7% vs 12%, p=0.008) at discharge. The 1-year MACCE rate was similar between groups (14.5% vs 9.8%, log-rank p=0.719), and Cox regression analyses adjusting for confounders revealed no significant difference (HR 1.408 (95% CI 0.622 to 3.191), p=0.412). Both groups demonstrated significant improvements in valve haemodynamics, with comparable rates of BVD (11.4% vs 9.2%, p=0.502) and structural valve dysfunction. Multivariate analysis demonstrated equivalent long-term survivals (HR 0.950 (95% CI 0.526 to 1.714), p=0.864) between groups. CONCLUSION: TAVR provides comparable clinical and haemodynamic outcomes for bicuspid and tricuspid AS with a small aortic annulus, despite greater procedural complexity in BAV cases. These findings support cautious expansion of TAVR to select BAV patients when performed with meticulous procedural planning.
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Sheng et al. (2025) conducted an observational in Severe aortic stenosis with small aortic annulus (n=427). Bicuspid aortic valve anatomy vs. Tricuspid aortic valve anatomy was evaluated on Major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality, stroke and rehospitalisation for heart failure at 1 year (HR 1.408, 95% CI 0.622-3.191, p=0.412). In patients with severe aortic stenosis and a small annulus undergoing TAVR, bicuspid anatomy was not associated with an increased risk of 1-year major adverse cardiac and cerebrovascular events compared to tricuspid anatomy (HR 1.408, p=0.412).
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