Comparative outcomes of transcatheter aortic valve replacement in bicuspid vs. tricuspid aortic valve stenosis patients: insights from the SWEDEHEART registry

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-05-14 DOI:10.1016/j.ijcha.2025.101705

Antros Louca , Petur Petursson , Joakim Sundström , Araz Rawshani , Henrik Hagström , Magnus Settergren , Stefan James , Sasha Koul , Kristofer Skoglund , Dan Ioanes , Sebastian Völz , Anna Myredal , Oskar Angerås , Truls Råmunddal

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引用次数: 0

Abstract

Background

Limited data exist on transcatheter aortic valve replacement (TAVR) outcomes in patients with bicuspid aortic valve (BAV) stenosis. This study compared TAVR outcomes in BAV versus tricuspid aortic stenosis.

Methods

This observational study included all patients who underwent TAVR in Sweden from 2016 to 2022, excluding those with pure aortic insufficiency and valve-in-valve procedures. Only Evolut-, SAPIEN-, ACURATE-, and Portico/Navitor-family devices were included. A doubly robust method was used, combining propensity score estimation and multivariable regression.

Results

Among 7,095 patients, 577 (8.1 %) had BAV stenosis. The mean EUROSCORE II-predicted mortality risk was 3.8 % for BAV and 4.5 % for TAV. BAV patients were younger, predominantly male, and had fewer comorbidities but higher baseline aortic valve gradients, larger annulus diameters, and more reduced ejection fraction.

After matching, 30-day mortality and all-cause mortality (median follow-up: 690 days) were similar between BAV and TAV patients (p = 0.8 for both). While BAVs had numerically lower technical success per VARC-3 criteria, this was not statistically significant (p = 0.08). However, BAV patients had lower device success (aOR = 0.8, p = 0.04) and a higher incidence of post-TAVR pacemaker implantation (aOR = 1.76, 95 % CI: 1.14–2.58, p = 0.007). No significant differences were observed in prosthesis-patient mismatch (p = 0.3), paravalvular leakage (p = 0.6), stroke (p = 0.3), or post-TAVR gradients (p > 0.9).

Conclusion

TAVR in BAV patients yields similar mortality and hemodynamic outcomes as in TAV patients. However, BAVs are associated with lower device success and higher pacemaker rates. While TAVR is a viable alternative to SAVR, treatment should be individualized, especially in younger BAV patients, considering lifetime management and coronary access.

查看原文本刊更多论文

经导管主动脉瓣置换术治疗二尖瓣和三尖瓣主动脉瓣狭窄患者的比较结果：来自SWEDEHEART登记的见解

关于双尖瓣主动脉瓣（BAV）狭窄患者经导管主动脉瓣置换术（TAVR）结果的数据有限。本研究比较了BAV和三尖瓣主动脉狭窄患者的TAVR结果。该观察性研究纳入了2016年至2022年在瑞典接受TAVR的所有患者，不包括单纯主动脉功能不全和瓣中瓣手术的患者。仅包括Evolut-， SAPIEN-， accurate -和Portico/ navitor -系列设备。采用双稳健方法，结合倾向得分估计和多变量回归。结果7095例患者中，577例（8.1%）发生BAV狭窄。EUROSCORE ii预测的BAV和TAV的平均死亡风险分别为3.8%和4.5%。BAV患者较年轻，以男性为主，合并症较少，但基线主动脉瓣梯度较高，主动脉环直径较大，射血分数降低较多。匹配后，BAV和TAV患者的30天死亡率和全因死亡率（中位随访：690天）相似（两者p = 0.8）。虽然按VARC-3标准，bav的技术成功率在数值上较低，但这在统计学上并不显著（p = 0.08）。然而，BAV患者的器械成功率较低（aOR = 0.8, p = 0.04）， tavr后起搏器植入的发生率较高（aOR = 1.76, 95% CI: 1.14-2.58, p = 0.007）。在假体-患者不匹配（p = 0.3）、瓣旁漏（p = 0.6）、卒中（p = 0.3）或tavr后梯度(p >；0.9)。结论BAV患者的tavr与TAV患者的死亡率和血流动力学结果相似。然而，bav与较低的设备成功率和较高的起搏器率相关。虽然TAVR是SAVR的可行替代方案，但治疗应个体化，特别是年轻BAV患者，考虑终身管理和冠状动脉通路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.