In patients with bicuspid aortic valve stenosis, TAVI was associated with a significantly higher risk of all-cause mortality compared to SAVR (adjusted HR 5.9).
Cohort (n=480)
No
Does transcatheter aortic valve implantation (TAVI) improve all-cause mortality compared to surgical aortic valve replacement (SAVR) in adult patients with bicuspid aortic valve stenosis?
In patients with bicuspid aortic valve stenosis, surgical aortic valve replacement is associated with significantly better long-term survival and fewer complications compared to transcatheter aortic valve implantation.
Hazard Ratio: 5.9 (95% CI 2.6–12.9)
Absolute Event Rate: 37% vs 11%
p-value: p=<0.001
Background Aortic valve stenosis can be treated surgically or with transcatheter aortic valve implantation (TAVI). However, bicuspid aortic valve (BAV) anatomy presents unique challenges that may affect procedural outcomes. We aimed to compare outcomes between the two approaches. Methods a retrospective cohort of 480 patients with BAV stenosis: 75 (16%) underwent TAVI and 405 (84%) underwent SAVR. Median age was 76 (Q1–Q3: 72–82) in the TAVI group and 61 (Q1–Q3: 52–70) in the SAVR group. Patients with isolated aortic insufficiency were excluded. Primary analyses were adjusted for age, sex, and comorbidities, followed by a sensitivity analysis using 1:1 age matching. Outcomes included overall survival, stroke/TIA, pacemaker implantation, paravalvular leak, and heart failure hospitalizations. Results During a mean follow-up of 9 ± 5 years, 72 patients died (28 TAVI, 44 SAVR). TAVI was associated with higher mortality (adjusted HR = 5.9, 95% CI 2.6–12.9, p 0.001), higher rates of pacemaker implantation (19% vs. 4%; HR = 2.6, 95% CI 1.1–6.7, p 0.001), paravalvular leak (adjusted OR = 5.8, 95% CI 2.6–12.7, p 0.001) and heart failure hospitalizations (IRR=7.7, 95% CI 2.7–22.2, p 0.001). Stroke rates were similar. Age-matched analyses confirmed higher mortality (adjusted HR = 3.6, 95% CI 1.5–8.6, p = 0.004), increased pacemaker implantation (adjusted HR = 3.9, 95% CI 1.04–14.5, p = 0.002), and heart failure hospitalizations (IRR=7.7, 95% CI 3.9–15.1, p 0.001). Conclusions In BAV stenosis, SAVR was associated with better survival and fewer complications than TAVI, while stroke/TIA rates were similar. Randomized trials are needed to determine the optimal treatment approach.
Faierstein et al. (Thu,) conducted a cohort in Bicuspid aortic valve stenosis (n=480). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on All-cause mortality (HR 5.9, 95% CI 2.6-12.9, p=<0.001). In patients with bicuspid aortic valve stenosis, TAVI was associated with a significantly higher risk of all-cause mortality compared to SAVR (adjusted HR 5.9).
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