Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

• DOI: 10.1007/s00392-020-01761-3
• Publication Date: 2020-10-24T15:02:52Z
• Authors: Annastiina Husso; Juhani Airaksinen; Tatu Juvonen; Mika Laine; Sebastian Dahlbacka; Marko Virtanen; Matti Niemelä; Timo Mäkikallio; Mikko Savontaus; Markku Eskola; Peter Raivio; Antti Valtola; Fausto Biancari
• Keywords: Male; 3126; Time Factors; Bicuspid aortic valve; SOCIETY; Surgery, anesthesiology, intensive care, radiology; 610; VALVULAR HEART-DISEASE; TAVR; 3121 Internal medicine; STENOSIS; Severity of Illness Index; 3121; TAVI; Transcatheter Aortic Valve Replacement; 03 medical and health sciences; 0302 clinical medicine; Bicuspid Aortic Valve Disease; Risk Factors; MANAGEMENT; Humans; Registries; Propensity Score; Aged; Retrospective Studies; ta3126; OUTCOMES; Original Paper; Aortic stenosis; ASSOCIATION; ta3121; 3126 Surgery, anesthesiology, intensive care, radiology; CALCIFICATION; General medicine, internal medicine and other clinical medicine; Aortic valve replacement; 3. Good health; Treatment Outcome; Transcatheter; Aortic Valve; Heart Valve Prosthesis; Female; IMPLANTATION; COLLEGE; Tomography, X-Ray Computed; TASK-FORCE; Follow-Up Studies

Abstract Objectives To compare the outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) for severe stenosis of bicuspid aortic valve (BAV).

Methods We evaluated the early and mid-term outcome of patients with stenotic BAV who underwent SAVR or TAVR for aortic stenosis from the nationwide FinnValve registry.

Results The FinnValve registry included 6463 AS patients and 1023 (15.8%) of them had BAV. SAVR was performed in 920 patients and TAVR in 103 patients with BAV. In the overall series, device success after TAVR was comparable to SAVR (94.2% vs. 97.1%, p = 0.115). TAVR was associated with increased rate of mild-to-severe paravalvular regurgitation (PVR) (19.4% vs. 7.9%, p < 0.0001) and of moderate-to-severe PVR (2.9% vs. 0.7%, p = 0.053). When newer-generation TAVR devices were evaluated, mild-to-severe PVR (11.9% vs. 7.9%, p = 0.223) and moderate-to-severe PVR (0% vs. 0.7%, p = 1.000) were comparable to SAVR. Type 1 N-L and type 2 L-R/R-N were the BAV morphologies with higher incidence of mild-to-severe PVR (37.5% and 100%, adjusted for new-generation prostheses p = 0.025) compared to other types of BAVs. Among 75 propensity score-matched cohorts, 30-day mortality was 1.3% after TAVR and 5.3% after SAVR (p = 0.375), and 2-year mortality was 9.7% after TAVR and 18.7% after SAVR (p = 0.268)

Conclusions In patients with stenotic BAV, TAVR seems to achieve early and mid-term results comparable to SAVR. Type 1 N-L and type 2 L-R/R-N BAV morphologies had higher incidence of PVR. Larger studies evaluating different phenotypes of BAV are needed to confirm these findings.

Clinical trial registration ClinicalTrials.gov Identifier: NCT03385915.

Graphic abstract