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

Louca, Antros ; Petursson, Petur ; Sundström, Joakim ; Rawshani, Araz ; Hagström, Henrik ; Settergren, Magnus ; James, Stefan ; Koul, Sasha LU ; Skoglund, Kristofer and Ioanes, Dan , et al. (2025) In IJC Heart and Vasculature 59.
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... (More)

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.

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type
Contribution to journal
publication status
published
subject
keywords
Aortic Valve Stenosis, Bicuspid Aortic Valve, Transcatheter Aortic Valve Replacement
in
IJC Heart and Vasculature
volume
59
article number
101705
publisher
Elsevier
external identifiers
  • scopus:105004918585
  • pmid:40486936
ISSN
2352-9067
DOI
10.1016/j.ijcha.2025.101705
language
English
LU publication?
yes
id
391a72a9-6b58-4d12-8f89-1a8ab9badaec
date added to LUP
2025-07-18 08:18:59
date last changed
2025-07-19 03:00:06
@article{391a72a9-6b58-4d12-8f89-1a8ab9badaec,
  abstract     = {{<p>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 &gt; 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.</p>}},
  author       = {{Louca, Antros and Petursson, Petur and Sundström, Joakim and Rawshani, Araz and Hagström, Henrik and Settergren, Magnus and James, Stefan and Koul, Sasha and Skoglund, Kristofer and Ioanes, Dan and Völz, Sebastian and Myredal, Anna and Angerås, Oskar and Råmunddal, Truls}},
  issn         = {{2352-9067}},
  keywords     = {{Aortic Valve Stenosis; Bicuspid Aortic Valve; Transcatheter Aortic Valve Replacement}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{IJC Heart and Vasculature}},
  title        = {{Comparative outcomes of transcatheter aortic valve replacement in bicuspid vs. tricuspid aortic valve stenosis patients : insights from the SWEDEHEART registry}},
  url          = {{http://dx.doi.org/10.1016/j.ijcha.2025.101705}},
  doi          = {{10.1016/j.ijcha.2025.101705}},
  volume       = {{59}},
  year         = {{2025}},
}