Key result
TAVI in bicuspid valves shows similar mortality to tricuspid, but ~35% higher 30-day stroke risk.
Why the study?
Outcomes of TAVI in patients with bicuspid aortic valve and severe aortic stenosis remain uncertain because this population was largely excluded from major clinical trials.
Does transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) anatomy result in comparable 30-day and one-year all-cause mortality compared to tricuspid aortic valve (TAV) anatomy in patients with severe aortic stenosis?
Meta-Analysis (n=219,071)
Does transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) anatomy result in comparable 30-day and one-year all-cause mortality compared to tricuspid aortic valve (TAV) anatomy in patients with severe aortic stenosis?
In a large meta-analysis of 219,071 patients, TAVI in bicuspid aortic valves showed similar 30-day and 1-year mortality compared to tricuspid aortic valves, but carried significantly higher risks of 30-day stroke, conversion to surgery, and paravalvular leakage.
Comparable 30-day mortality supports TAVI feasibility in bicuspid valves; leaves open randomized confirmation of complication risks.
Background Outcomes of transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) and severe aortic stenosis remain uncertain, largely because this population was excluded from major clinical trials. Purpose This meta-analysis aims to compare major clinical outcomes of TAVI in BAV and tricuspid aortic valve (TAV) patients. Methods A comprehensive literature search was conducted across PubMed, Scopus, and Cochrane databases to identify relevant studies. Our primary endpoints were 30-day and one year all-cause mortality. Secondary endpoints included 30-day Stroke, major or life-threatening bleeding events, periprocedural vascular complications, and permanent pacemaker implantation (PPM) up to 30 days, as well as aortic root injury, conversion to cardiac surgery, coronary obstruction, paravalvular leakage (pvl), and prosthesis-patient mismatch. Statistical analysis included Risk Ratio (RR) with 95% confidence interval (CI) using the random-effects model (Mantel-Haenszel). Results A total of 38 studies, involving 219,071 patients, were included in the meta-analysis. There was no significant difference regarding 30-day Mortality (Risk Ratio (RR): 1.34, 95% Confidence Intervals (CI): 0.88-2.04) and one-year mortality (RR: 0.86, 95% CI: 0.73-1.00) were similar between the two groups. However, the risk of 30-day stroke (RR: 1.35, 95% CI: 1.10-1.43), conversion to cardiac surgery (RR: 1.45, 95% CI: 1.12-1.87), and pvl (RR: 1.37, 95% CI: 1.22-1.53) were higher in the BAV group compared with TAV group. No differences were observed in the remaining secondary endpoints. Conclusion TAVI in BAV demonstrates acceptable short-term safety compared with TAV. However, the incidence of certain procedural complications is higher in BAV patients than in those with TAV and should be considered during the decision-making process. Further randomized studies are required to establish long-term clinical outcomes and durability.
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Theodoropoulou et al. (2026) conducted a meta-analysis in Severe aortic stenosis with bicuspid or tricuspid aortic valve undergoing TAVI (n=219,071). Transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) vs. Transcatheter aortic valve implantation (TAVI) in tricuspid aortic valve (TAV) was evaluated on 30-day and one-year all-cause mortality (RR 1.34 (30-day); RR 0.86 (1-year), 95% CI 0.88-2.04 (30-day); 0.73-1.00 (1-year)). TAVI in bicuspid vs tricuspid aortic valves had similar 30-day (RR 1.34; 95% CI 0.88-2.04) and 1-year mortality (RR 0.86; 95% CI 0.73-1.00), but higher 30-day stroke (RR 1.35; 95% CI 1.10-1.43).
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