Surgical Versus Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis: 1-Year Clinical Outcomes in Patients Aged 65 Years and Older.
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Hemelrijk Kimberley Iris, Mon Noboa Matias R, Tirado-Conte Gabriela, Winkelman Toon, Asmarats Lluis, Rosello-Diez Elena, Perez-Camargo Daniel, Kobari Yusuke, Guitteny Thibaut, McInerney Angela, Margarida Adrián, Munoz-Garcia Antonio, Gomez-Herrero Javier, Castro-Mejía Alex, Prieto-Lobato Alicia, Oteo Domínguez Juan Francisco, Lopez Otero Diego, Campelo-Parada Francisco, Veiga Gabriela, Casellas-Casanovas Sandra, Jimenez-Quevedo Pilar, Arellano Serrano Carlos, Jimenez-Mazuecos Jesus M, Bustamante Munguira Juan, Gonzalo Nieves, de la Torre Hernandez Jose M, Amat Santos Ignacio J, Arzamendi Dabit, Carnero Manuel, Mylotte Darren, De Backer Ole, Delewi Ronak, Nombela-Franco Luis
Аннотация
METHODS: In this multicenter observational study, patients with bicuspid aortic stenosis undergoing TAVR or SAVR were analyzed using propensity score matching. The primary outcome was a composite of all-cause mortality, stroke, rehospitalization, or valve dysfunction at 1 year.
RESULTS: A total of 997 patients with bicuspid aortic stenosis underwent TAVR or SAVR. In the matched cohort of 256 pairs, the median age was 75.0 years (interquartile range, 71.0-78.0), 234 (44.9%) were women, and the median EuroScore II was 1.83% (interquartile range, 1.34-2.86). One-year cumulative incidence of the primary outcome was 15.0% in TAVR compared with 12.0% in SAVR (hazard ratio [HR], 1.35 [95% CI, 0.83-2.19], P=0.23). Mortality (4.3% versus 5.0%, P=0.72) and rehospitalization (4.8% versus 6.4%, P=0.45) were similar between groups. Although rates of valve dysfunction (2.9% versus 0.5%, P=0.06) and stroke (5.3% versus 2.3%, P=0.10) were numerically lower in the surgical group at 1 year, both the risk of stroke (subdistribution HR, 3.01, P=0.02) and valve dysfunction (subdistribution HR, 4.16, P=0.03) were significantly higher in the TAVR group at 2 years.
CONCLUSIONS: TAVR in patients with bicuspid aortic stenosis showed a similar 1-year primary outcome rate compared with SAVR, though TAVR exhibited higher rates of valve dysfunction and stroke. These findings underscore the need for randomized trials to define the optimal treatment strategy for this population.