Key result
Transcatheter aortic valve replacement in patients with bicuspid aortic valve stenosis demonstrated promising outcomes with a 30-day mortality of 2.1% and a 1-year mortality of 9.6%.
Why the study?
BAV remains a relative contraindication for TAVR due to suboptimal anatomy, but increasing adoption as an alternative to surgical repair warranted analysis of available outcome and mortality data.
Meta-Analysis (n=1,945)
TAVR in patients with bicuspid aortic valve stenosis demonstrates promising short- and mid-term outcomes with low rates of complications and mortality, supporting its potential as an alternative to surgical replacement.
Background: Currently, bicuspid aortic valve (BAV) anatomy remains a relative contraindication for transcatheter aortic valve replacement (TAVR) due to concerns of suboptimal anatomy. However, recent advancements in the field have provided a wealth of promising data and more clinicians are opting for TAVR as an alternative to surgical repair. We aim to review and analyze the available data for TAVR in BAV patients, targeting procedural outcomes, clinical outcomes and mortality with up to two years of follow-up. Methods: A literature search of five databases was performed and all primary studies published between 2002 and 2021 that reported procedural, clinical or mortality outcome data were identified. Following data extraction, a meta-analysis of means or proportions was performed using a random effects model. Heterogeneity was assessed using the I2 statistic. Results: A total of 22 studies with 1,945 BAV patients were identified. The mean age was 74.1 years and 58.8% of patients were male. Device success rates was 87.5%. Moderate to severe paravalvular leak (PVL) was seen in 3.7% of procedures. Clinical outcomes included new permanent pacemaker insertion (PPI) (11.8%), major bleeding (3.5%), major vascular complications (2.5%), stroke (2.3%), acute kidney injury (2.1%) and coronary obstruction (0.1%). Mortality in hospital, at 30-days, one and two years of follow-up were 1.9%, 2.1%, 9.6% and 12.9%, respectively. Conclusions: This assessment of the available data on TAVR for BAV shows promising outcomes and low rates of complications. However, further research is warranted to reduce the heterogeneity of the available data and provide insight into outcomes beyond two years of follow-up.
No takes yet. Share an insight, caveat, or question.
Chen et al. (2022) conducted a meta-analysis in Bicuspid aortic valve (BAV) stenosis (n=1,945). Transcatheter aortic valve replacement (TAVR) was evaluated on 30-day all-cause mortality (95% CI 1.2-2.9). Transcatheter aortic valve replacement in patients with bicuspid aortic valve stenosis demonstrated promising outcomes with a 30-day mortality of 2.1% and a 1-year mortality of 9.6%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: