Key result
Sievers type 0 bicuspid aortic valves show similar 30-day mortality to type 1 after TAVI.
Why the study?
While TAVI has achieved satisfactory outcomes in selected BAV patients (predominantly type 1), reports on the safety and efficacy of TAVI in type 0 BAV are scarce.
Does TAVI in Sievers type 0 BAV compared to type 1 BAV affect procedural and 30-day outcomes in patients with bicuspid aortic stenosis?
Meta-Analysis (n=1,128)
Yes
Does TAVI in Sievers type 0 BAV compared to type 1 BAV affect procedural and 30-day outcomes in patients with bicuspid aortic stenosis?
TAVI in Sievers type 0 BAV yields similar short-term mortality to type 1 BAV but is associated with a significantly higher risk of coronary obstruction and suboptimal hemodynamics.
Answers are grounded in this paper and cite their sources.
Supports TAVI feasibility in Sievers type 0 BAV; extends observational meta-analysis but leaves coronary and hemodynamic risks open.
Background: Transcatheter aortic valve implantation (TAVI) has achieved satisfactory outcomes in the selected patients with bicuspid aortic valve (BAV), predominately type 1 BAV (~90%). However, there are few reports about the safety and efficacy of TAVI in type 0 BAV. Therefore, in the current study, we aimed to compare procedural and 30-day outcomes after TAVI between type 0 and type 1 BAV. Methods: Studies comparing the outcomes of TAVI in Sievers type 0 vs. type 1 BAV were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science from inception to May 2021. The data were extracted regarding the study characteristics and outcomes. The odds ratios (ORs) with 95% CIs were pooled for procedural and 30-day outcomes. Results: Six observational studies were included with determined type 0 BAV in 226 patients and type 1 BAV in 902 patients. The patients with type 0 BAV were slightly younger, had larger supra-annular structure, and more frequently implanted self-expanding prosthesis compared with type 1 BAV. In the pooled analyses, the patients with type 0 BAV had a similar incidence of procedural death (OR = 2.6, 95% CI 0.7–10.3), device success (OR = 0.6; 95% CI 0.3–1.3), and ≥ mild (OR = 0.8; 95% CI 0.4–1.6) or moderate (OR = 0.9, 95% CI 0.4–1.8) paravalvular leak, whereas significantly higher mean aortic gradient (mean difference = 1.4 mmHg, 95% CI 0.03–2.7) and increased coronary compromise risk (OR = 7.2; 95% CI 1.5–34.9), compared with type 1 BAV. Meanwhile, the incidence of death (OR = 1.2; 95% CI 0.5–3.1), stroke (OR = 0.5; 95% CI 0.1–2.4), and new pacemaker (OR = 0.6; 95% CI 0.2–2.2) at 30 days were not significantly different between the BAV morphologies ( p > 0.05). The treatment effect heterogeneity across the studies for the above outcomes were low. Conclusions: The patients with type 0 BAV appear to have similar short-term outcomes after TAVI compared with type 1 BAV. Whereas, TAVI for type 0 BAV aortic stenosis might lead to an elevated coronary obstruction risk and suboptimal aortic valvular hemodynamics.
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Du et al. (2021) conducted a meta-analysis in Severe aortic stenosis with bicuspid aortic valve (n=1,128). Sievers type 0 bicuspid aortic valve morphology vs. Sievers type 1 bicuspid aortic valve morphology was evaluated on 30-day mortality (OR 1.2, 95% CI 0.5-3.1, p=>0.05). Patients with Sievers type 0 bicuspid aortic valve morphology had a similar incidence of 30-day mortality (OR 1.2) compared with type 1 morphology after transcatheter aortic valve implantation.
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