Comparison of short- and long-term outcomes between transcatheter and surgical aortic valve replacement for bicuspid aortic valve stenosis: a systematic review and meta-analysis.

OBJECTIVE

This meta-analysis aimed to compare the perioperative safety and efficacy of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in bicuspid aortic valve (BAV) stenosis.

METHODS

We systematically analyzed studies from PubMed, Cochrane Library, Embase, and CNKI comparing TAVR and SAVR in BAV stenosis. Outcomes included postoperative mortality, complications, all-cause survival, and freedom from stroke. Data were pooled using random-effects models.

RESULTS

Fifteen studies ( n = 22 085; TAVR = 7840, SAVR = 14 245) were included. No significant difference regarding postoperative mortality between TAVR and SAVR in the whole patient cohort (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.64-1.13; I2 = 16.13%) or adjusted patient cohort (OR: 0.85, 95% CI: 0.55-1.32; I2 = 40.28%) was observed. TAVR was associated with reduced risks of acute kidney injury (OR: 0.51, 95% CI: 0.35-0.75; I2 = 88.94%) and major bleeding (OR: 0.42, 95% CI: 0.21-0.84; I2 = 95.45%) but increased risks of permanent pacemaker implantation (OR: 2.47, 95% CI: 1.61-3.78; I2 = 86.48%) and paravalvular leak (OR: 4.39, 95% CI: 1.32-14.61; I2 = 72.93%). Landmark survival analysis demonstrated superior all-cause survival for SAVR beyond 6 months ( P < 0.001). In addition, patients with BAV stenosis receiving SAVR had better freedom from stroke ( P < 0.001). The certainty of evidence was low for several key outcomes due to study limitations.

CONCLUSION

TAVR achieves comparable postoperative mortality to SAVR in BAV stenosis with fewer acute complications but inferior long-term survival and higher device-related risks. SAVR demonstrates durable survival benefits and enhanced stroke prevention, underscoring the need for individualized selection based on anatomy and life expectancy.