Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Bicuspid aortic valve (BAV) anatomy presents unique challenges for transcatheter aortic valve replacement (TAVR) compared to tricuspid aortic valve (TAV).
• Understanding clinical adverse events and device efficacy in BAV patients undergoing TAVR is crucial for optimizing patient selection and procedural outcomes.

Approach:

• Systematic review and meta-analysis of observational studies and randomized controlled trials.
• Comparison of TAVR outcomes in BAV vs. TAV populations, stratified by early- and new-generation devices.
• Analysis of balloon-expandable (BE) vs. self-expanding (SE) valve performance in BAV patients.

Key Points:

• BAV patients had higher risks of conversion to surgical aortic valve replacement (SAVR), need for a second valve, moderate/severe paravalvular leakage (PVL), device failure, acute kidney injury (AKI), stroke, and permanent pacemaker implantation (PPI).
• BAV patients demonstrated a significantly lower risk of 1-year mortality compared to TAV patients (OR = 0.85).
• BE valves showed higher annular rupture risk but lower need for a second valve and new PPI compared to SE valves; new-generation devices generally had lower adverse event rates.

Conclusions:

• TAVR is a viable option for selected severe bicuspid aortic stenosis (AS) patients, offering potential 1-year survival benefits, particularly with new-generation devices in lower-risk populations.
• Despite increased risks of certain complications, TAVR in BAV patients warrants consideration, especially with advancements in device technology.
• Further large-scale randomized studies are necessary to refine patient selection criteria and confirm the long-term durability of transcatheter heart valves (THVs) in the BAV population.