Meta-Analysis of TAVR Versus SAVR in Bicuspid Valve: Mortality, Complications, and Long-Term Outcomes.

Abstract

Introduction: Bicuspid Aortic Valve (BAV) is the most common congenital heart disease and often causes aortic stenosis in younger adults. There are few prospective randomized trials comparing Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement (SAVR) in BAV patients, since these patients are usually excluded from major studies because of their complex anatomy. A meta-analysis to compare clinical outcomes between TAVR and SAVR in people with BAV was conducted.

Methods: PubMed, Google Scholar, and SCOPUS were searched for studies published up to December 2023 that compared TAVR and SAVR in patients with BAV. The main outcomes that were examined were mortality, atrial fibrillation, permanent pacemaker implantation, stroke, respiratory complications, and acute kidney injury. Forward and backward citation searches were also used. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals, and heterogeneity was assessed using the I² statistic. Sensitivity analyses were performed by removing one study at a time.

Results: The analysis included seven studies with a total of 96,430 BAV patients. Of these, 41,110 had TAVR and 55,320 had SAVR. Patients who had TAVR were less likely to experience in-hospital respiratory complications, bleeding or need for transfusion, and new-onset atrial fibrillation. However, they were more likely to need a permanent pacemaker. There were no significant differences between the groups in short-term mortality, stroke, or acute kidney injury.

Discussion: Lower peri-procedural morbidity with TAVR likely reflects its minimally invasive nature, whereas higher pacemaker rates may relate to bicuspid valve anatomy and conduction system vulnerability.

Conclusion: TAVR appears to be a reasonable alternative to SAVR in carefully selected BAV patients, but randomized trials and long-term follow-up remain necessary.