Bicuspid aortic valve interventions in Texas—2009–2019

Background: Bicuspid aortic valve (BAV) is a common congenital heart defect occurring in 0.5–2% of adults. It is associated with increased lifetime risk of aortic valve intervention (AVI). Different AVI options include surgical replacement [surgical aortic valve replacement (SAVR)], repair, the Ross procedure, and transcatheter replacement [transcatheter aortic valve replacement (TAVR)]. This study seeks to evaluate statewide trends in BAV AVI and compare in-hospital outcomes over 11 years period. Methods: A retrospective review of the Texas Inpatient Discharge Dataset from 1/1/2009–12/31/2019 was conducted. All non-trauma discharges of patients ≥18 years from acute care hospitals were included. BAV discharges, types of AVI, and outcomes were identified by International Classification of Diseases 9th and 10th revision (ICD-9/10) diagnosis codes. Descriptive, univariate, and logistic regression statistics were utilized. Results: A total of 22,154,664 eligible discharges were identified, of which 10,393 (0.05%) were BAV discharges of which 5,429 (52.2%) underwent AVI, including included 126 (2.3%) repair, 204 (3.8%) TAVR, 5,015 (92.4%) SAVR and 84 (1.5%) Ross procedures. After adjusting for patient characteristics, SAVR had the longest length of stay (LOS) (P<0.001), the Ross procedure had an increased odds of acute renal failure (P=0.010) and TAVR an increased odds of permanent pacemaker placement (P=0.029) compared to repair. No difference was found in in-hospital mortality. Conclusions: The number of BAV AVI discharges increased steadily over the study period. Different BAV AVI types are associated with different complication profile, including need for permanent pacemaker placement and acute renal failure. These differential risks should be utilized to inform patients and families to allow for more robust shared decision making within care plans for those with BAV.