Long-Term Outcomes of Contemporary Balloon-Expandable TAVR in Bicuspid Aortic Valve: A Propensity-Matched Comparison to Tricuspid.

Background

Limited data are available comparing clinical outcomes between bicuspid and tricuspid patients following transcatheter aortic valve replacement (TAVR).

Objectives

This study sought to investigate 5-year clinical outcomes in patients with severe aortic stenosis following TAVR with contemporary balloon-expandable valves (BEVs) in patients with bicuspid vs tricuspid leaflet morphology.

Methods

From August 2015 to December 2023, a total of 3,393 patients with native aortic stenosis who underwent TAVR with contemporary BEVs were divided into bicuspid and tricuspid groups. A 1:1 propensity score-matched analysis was performed to adjust for baseline differences. The primary endpoint was all-cause mortality at 5-year follow-up.

Results

Among 515 matched pairs, over a median follow-up duration of 1,511 days (Q1-Q3: 937-1825 days), there were no significant differences in all-cause mortality (13.2% vs 13.7%; P = 0.384). Heart failure rehospitalization (8.5% vs 6.8%; P = 0.622), stroke (2.4% vs 2.6%; P = 0.618), or aortic valve reintervention (0.7% vs 1.6%; P = 0.706) at 5 years was not significantly different between the groups. Ascending aortic growth rates (0.37 mm/y vs 0.31 mm/y; P = 0.578), in-hospital death (0.8% vs 1.0%; P = 0.738), valve hemodynamics through 5 years, including mean transvalvular gradients (12.0 mm Hg vs 11.5 mm Hg; P = 0.863), effective orifice area (1.35 cm2 vs 1.50 cm2, P = 0.084), and moderate or greater paravalvular leak (3.9% vs 5.6%; P = 0.578) did not differ significantly between groups.

Conclusions

In propensity score-matched patients undergoing TAVR with contemporary BEVs, long-term clinical outcomes, valve performance, and ascending aortic growth rate showed no statistically significant differences between bicuspid and tricuspid groups.