Howard C. Herrmann, MD reviewing Yoon S-H et al. J Am Coll Cardiol 2017 Mar 18.

TAVR results in bicuspid AS are encouraging, but caution is still warranted.

As transcatheter aortic valve replacement (TAVR) continues to expand to lower-risk and younger patients with aortic stenosis (AS), more patients with bicuspid AS are being considered despite being excluded from randomized trials. In this international observational registry of patients undergoing TAVR, 546 patients with mostly (86%) Sievers type 1 bicuspid valves were compared to a propensity-matched cohort of patients with tricuspid valves. Mean age at baseline was 77 years; 62% were male; mean STS risk was 4.5%. Transfemoral access was used in 86% of patients with a variety of devices, distributed similarly between cohorts.

Procedural mortality was similar in the bicuspid and tricuspid groups (1.3% vs. 1.1%); however, conversion to surgery (2.0% vs. 0.2%), need to implant two valves (4.8% vs. 1.5%), and moderate or severe paravalvular aortic regurgitation (10.4% vs. 6.8%) were all significantly higher in the bicuspid group, resulting in a lower rate of overall device success (85% vs. 91%). There was no difference in all-cause mortality, stroke, or bleeding at 30 days, and no difference in all-cause mortality at 2 years.

CITATION(S):

Yoon S-H et al. Procedural and clinical outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol 2017 Mar 18; [e-pub]. 

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