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Long-Term Outcomes of BAV-0 Patients Compared With BAV-1 and TAV Patients After TAVR
Weiya Li1, Yuheng Jia2, Hongde Li1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China; Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
Background:
Differences in long-term clinical outcomes following transcatheter aortic valve replacement (TAVR) in different anatomical subtypes of aortic valve stenosis (AS), specifically tricuspid aortic valves (TAV) and bicuspid aortic valves (BAV) of types 0 (BAV-0) and 1 (BAV-1), are not well understood.
Objectives:
The authors sought to report and compare the long-term clinical outcomes among patients with different anatomical subtypes of AS undergoing TAVR.
Methods:
We conducted an international retrospective cohort study involving patients who underwent TAVR for severe AS at 3 large, high-volume heart centers in China, Germany, and Denmark before October 2018. Five-year follow-up ended on October 30, 2023, and the primary endpoint was all-cause mortality.
Results:
A total of 2,553 AS patients (BAV-0: n = 134; BAV-1: n = 305; TAV: n = 2,114) who underwent TAVR more than 5 years ago were included. The mean age of this cohort was 79.9 ± 6.8 years, and the median Society of Thoracic Surgeons score was 3.6% [Q1-Q3: 2.4%-5.4%]. The median follow-up time was 3.24 years (Q1-Q3: 1.25-5.00 years). At 5 years, BAV-1 (adjusted HR: 2.38 [95% CI: 1.32-4.28]; P = 0.004) and TAV (adjusted HR: 3.02 [95% CI: 1.71-5.31]; P < 0.001) had a higher risk for all-cause mortality after TAVR compared with BAV-0. BAV patients who were treated with balloon-expandable valves had a higher long-term all-cause mortality (41.7% [28.5%-52.5%] vs 23.6% [17.9%-28.8%]; HR: 1.63 [95% CI: 1.05-2.51]; P = 0.028) compared with those with self-expanding valves.
Conclusions:
Among patients with severe AS undergoing TAVR, BAV-0 was associated with a better long-term prognosis compared with TAV and BAV-1.
