Transcatheter aortic valve implantation in patients with tricuspid, bicuspid and bioprosthetic valves: observations from COMPARE-TAVI 1.

Background. Transcatheter aortic valve implantation (TAVI) is most extensively documented for the treatment of aortic stenosis in patients with tricuspid valves. To compare the 30-day and 1-year outcomes after TAVI in patients with tricuspid, bicuspid and bioprosthetic valves who participated in the COMPARE-TAVI 1 trial. Methods. In COMPARE-TAVI 1, all-comer patients treated with transfemoral TAVI were randomized to treatment with one of two balloon-expandable valves. In this study, these patients were divided into three groups based on valve anatomy. 30-day and 1-year outcomes among patients with bicuspid and bioprosthetic valves (surgical or transcatheter) were compared with outcomes among patients with tricuspid valves. Results. Patients with tricuspid valves (N = 892, median 82 years) were slightly older than patients with bicuspid (N = 98, median 78 years) and bioprosthetic (N = 40, median 80 years) valves. Procedural outcomes were similar. There were no differences in death or bleeding at 30 days, nor in death, myocardial infarction, percutaneous revascularization, or endocarditis at 1 year. Stroke was more frequent among patients with bicuspid valves at 30 days (n = 7), while new pacemaker was less frequent among patients with bioprosthetic valves at 30 days (n = 0). The need for reoperation was more frequent among patients with bicuspid valves (n = 3). Conclusions. In this observational study performed within the COMPARE-TAVI 1 cohort, patients with tricuspid, bicuspid or bioprosthetic valves had similar outcomes. No patients with bioprosthetic valves had a new pacemaker within 30 days after TAVI. Clinical trial registration. ClinicalTrials.gov: NCT04443023.