Transcatheter aortic valve replacement for patients with severe bicuspid aortic stenosis

Abstract Objectives To evaluate the outcomes of TAVR in patients with bicuspid aortic valve stenosis (BAV) and compared them with those of trileaflet aortic valve stenosis (TAV). Background Patients with BAV were excluded from all the TAVR pivotal trials and therefore their outcomes are not clearly defined. Methods We evaluated the outcomes following TAVR of patients with BAV at our institution between April 2011 and November 2016, and compared them with the outcomes of patients with TAV treated with TAVR. The chi-square and the Mann–Whitney U tests were used to compare the groups, and a Kaplan–Meier analysis was performed to estimate long-term survival. Results TAVR was performed in a total of 567 patients, from which 50 (8.8%) had BAV and 517 (91.2%) TAV. Patients with BAV were younger, had higher prevalence of COPD, lower prevalence of coronary artery disease, higher BMI and lower STS score. Patients with BAV had a slightly higher mean aortic valve gradient postoperatively (median 12 mmHg [10–15] vs. 10 [7–13], P  mild 4.0% vs. 3.5, P = .541). Clinical outcomes were not different between the groups, including stroke (2.0% vs. 1.5, P = .567) and the 30-day all-cause mortality (6.0% vs. 1.5, P = .064). The 2-year survival (82.0% vs. 83.4, P = .476) was similar between the groups. Conclusions This initial experience suggests TAVR can be safely performed in patients with BAV achieving similar short-term procedural and clinical outcomes when compared with patients with TAV. Condensed Abstract The outcomes of 50 patients (8.8%) with bicuspid aortic stenosis (BAV) undergoing TAVR were compared with those of 517 patients (91.2%) with trileaflet aortic valve (TAV) stenosis. Patients with BAV were younger, had higher prevalence of COPD, lower prevalence of CAD, higher BMI and lower STS score. Major complications were similar between the groups, including stroke (2.0% vs. 1.5, P = .567), 30-day all-cause mortality (6.0% vs. 1.5, P = .064), and 2-year survival (82.0% vs. 83.4, P = .476). This initial experience suggests TAVR can be safely performed in patients with BAV achieving similar short-term procedural and clinical outcomes when compared with patients with TAV.