December 21, 2020Brazilian Journal of Cardiovascular SurgeryOpen Access

Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve with Aortic Stenosis: a Meta-Analysis and Trial Sequential Analysis

View Full Paper

Ask AI

Bookmark

Why the study?

Bicuspid aortic valve is an important aetiology of aortic stenosis, but the use of transcatheter aortic valve implantation had not been fully explored in this cohort.

Does transcatheter aortic valve implantation (TAVI) yield comparable clinical outcomes in patients with bicuspid aortic valve compared to tricuspid aortic valve?

Structured PICO

Does transcatheter aortic valve implantation (TAVI) yield comparable clinical outcomes in patients with bicuspid aortic valve compared to tricuspid aortic valve?

Population

3,996 patients with aortic stenosis (917 with bicuspid aortic valve and 3,079 with tricuspid aortic valve) pooled from 13 studies.

Intervention

Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV)

Comparator

Transcatheter aortic valve implantation (TAVI) in patients with tricuspid aortic valve (TAV)

Outcome

30-day and 1-year mortalityhard clinical

TAVI in bicuspid aortic valves yields comparable 30-day and 1-year mortality to tricuspid aortic valves, supporting its clinical viability despite higher rates of postoperative aortic regurgitation.

Implication

Supports TAVI consideration in selected BAV stenosis; leaves open questions on AR management and long-term outcomes.

Abstract

OBJECTIVES: Bicuspid aortic valve (BAV) is an important aetiology of aortic stenosis and the use of transcatheter aortic valve implantation (TAVI) has not been fully explored in this cohort. This systematic review and meta-analysis compared the outcomes of TAVI in stenotic BAV against tricuspid aortic valve (TAV). METHODS: An electronic literature search was performed in PubMed, MEDLINE, EMBASE, and Scopus to identify all studies comparing TAVI in stenotic BAV versus TAV. Only studies comparing TAVI in BAV versus TAV were included, without any limit on the study date. Primary endpoints were 30-day and 1-year mortality, while secondary endpoints were postoperative rates of stroke, acute kidney injury (AKI), and permanent pacemaker (PPM) requirement. A trial sequential analysis (TSA) was performed for all endpoints to understand their significance. RESULTS: Thirteen studies met the inclusion criteria (917 BAV and 3079 TAV patients). The BAV cohort was younger (76.8±7.43 years vs. 78.5±7.12 years, P=0.02), had a higher trans-aortic valve gradient (P=0.02), and larger ascending aortic diameters (P<0.0001). No significant difference was shown for primary (30-day mortality [P=0.45] and 1-year mortality [P=0.41]) and secondary endpoints (postoperative stroke [P=0.49], AKI [P=0.14], and PPM requirement [P=0.86]). The BAV group had a higher rate of significant postoperative aortic regurgitation (P=0.002). TSA showed that there was sufficient evidence to conclude the lack of difference in PPM requirements, and 30-day and 1-year mortality between the two cohorts. CONCLUSION: TAVI gives satisfactory outcomes for treating stenotic BAV and should be considered clinically.