Comparison between severe R-L and R-NC raphe-type bicuspid aortic valve stenosis treated with TAVI: insights from the...

Sievers type 1 bicuspid aortic valve (BAV) stenosis presents unique challenges for trans-catheter aortic valve implantation (TAVI), particularly when calcified raphe is present. The impact of raphe localization on TAVI outcomes remains unclear.

This study aimed to compare procedural and clinical outcomes in patients with right-left (R-L) and right-non coronary (R-NC) raphe-type BAV treated with TAVI.

Between January 2016 and October 2023, 956 consecutive patients with severe Sievers type 1 BAV stenosis underwent trans-femoral (TF)-TAVI across 24 tertiary centers. Pre-procedural computed tomography was retrospectively analyzed. To address the non-randomized study's design, 2:1 propensity score matching (PSM) was performed between R-L and R-NC groups. Primary endpoints included VARC-3 technical success, 30-day device success, early safety, and mid-term major adverse events (death, stroke, or heart failure hospitalization at the last follow-up).

825 had R-L raphe whereas 131 had R-NC pattern. After PSM, 251 R-L and 128 R-NC were analyzed. Baseline clinical, electrocardiographic, echocardiographic, computed tomography and procedural features were similar. Technical success was high in both groups (92.8 % vs 96.1 %; OR 0.53; 95%CI 0.19-1.45; p = 0.215), with comparable short- and mid-term outcomes. However, permanent pacemaker implantation (PPI) incidence was 3 times higher in R-L compared to R-NC (16.1 % vs. 6.7 %; OR 0.37, CI 0.16-0.89).

Raphe localization in Sievers type 1 BAV does not affect major TAVI outcomes except for PPI risk, which is 3-fold higher in R-L patients.