Transcatheter aortic valve replacement for bicuspid and tricuspid aortic stenosis exhibited similar outcomes for mortality and stroke

1. Mortality and stroke rates at 30-days and 1-year did not differ significantly between low-risk patients with bicuspid versus tricuspid aortic stenosis who underwent transcatheter aortic valve replacement.

2. Aortic hemodynamics and quality of life measures were similar between bicuspid and tricuspid aortic valve patients.

Evidence Rating Level: 2 (Good)

Study Rundown: Recent evidence has expanded the indication of transcatheter aortic valve replacement (TAVR) for younger patients regarded as a low surgical risk. These studies have excluded those with bicuspid aortic stenosis. This registry-based cohort study examined TAVR outcomes for bicuspid versus tricuspid aortic stenosis in patients considered a low surgical risk. The coprimary outcomes were mortality and stroke at 30-days and 1-year post-surgery. Participants were recruited from 684 United States centres and separated into two groups: those with a bicuspid aortic valve and those with a tricuspid aortic valve. There were significant differences in baseline characteristics, therefore the results are based on the propensity score-matched population. There was no significant difference in mortality rate between bicuspid and tricuspid participants at 30 days (0.9% vs. 0.8%; hazard ratio [HR]: 1.18 [95% CI: 0.69-2.03]; p= 0.55) and at 1 year (4.6% vs. 6.6%; HR: 0.75 [95% CI: 0.55-1.02]; p= 0.06). Additionally, there was no significant difference in stroke between groups at 30 days (1.4% vs. 1.2%; HR: 1.14 [95% CI: 0.73-1.78]; p= 0.55) and at 1 year (2.0% vs. 2.1%; HR: 1.03 [95% CI: 0.69-1.53]; p= 0.89). Both groups improved significantly when assessing aortic hemodynamics after surgery, and the mean aortic valve gradients did not significantly differ between cohorts at 30 days and 1 year. Both cohorts also had similarly low rates of moderate or severe paravalvular regurgitation. Lastly, both groups demonstrated significant improvement in the NYHA functional class I or II symptoms at 30 days and 1 year. Overall, patients with bicuspid and tricuspid aortic stenosis who were low surgical risk and underwent TAVR demonstrated similar outcomes regarding 30-day and 1-year mortality, stroke, and quality of life measures. Notably, although outcomes for bicuspid aortic stenosis were comparable to tricuspid aortic stenosis, these results do not indicate whether TAVR is superior to surgery for low surgical risk patients with bicuspid aortic stenosis.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Transcatheter aortic valve replacement in bicuspid aortic valve stenosis

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