Outcomes of transcatheter vs. surgical aortic valve replacement in bicuspid aortic valve stenosis: A systematic review and meta-analysis.

Abstract

This meta-analysis compared peri-procedural and short-term outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in severe bicuspid aortic valve (BAV) stenosis, addressing TAVR's debated efficacy in this context. A systematic search of PubMed, ScienceDirect, and Embase up to January 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I² statistic, with p < 0.05 as significant. 9 observational studies and 1 randomized controlled trial with 148,771 patients (TAVR: 16,584; SAVR: 132,187) were included. TAVR showed lower odds of acute kidney injury (OR = 0.58, 95% CI: 0.35-0.97; p = 0.04), major bleeding (OR = 0.29, 95% CI: 0.12-0.69; p = 0.005), and pulmonary complications (OR = 0.44, 95% CI: 0.34-0.57; p < 0.00001) versus SAVR. However, TAVR increased risks of paravalvular leak (OR = 2.15, 95% CI: 1.20-3.88; p = 0.01) and permanent pacemaker implantation (OR = 2.08, 95% CI: 1.39-3.10; p = 0.0004). No significant differences were noted in in-hospital mortality (OR = 1.04, 95% CI: 0.56-1.94; p = 0.89), stroke (OR = 1.05, 95% CI: 0.86-1.28; p = 0.65), or vascular complications (OR = 0.67, 95% CI: 0.18-2.52; p = 0.55). TAVR reduces risks of acute kidney injury, major bleeding, and pulmonary complications in BAV stenosis but raises paravalvular leak and pacemaker implantation risks compared to SAVR. Mortality and stroke rates are similar. TAVR may suit selected patients, but long-term data is needed.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02146-9.