Temporal Trends and In-hospital Outcomes of Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valves in Brazil: A Propensity-Matched Analysis.

BACKGROUND

Bicuspid aortic valve (BAV) is a significant risk factor for aortic stenosis (AS). Yet, the outcomes of transcatheter aortic valve implantation (TAVI) remain unclear, as most randomized trials excluded such patients. Furthermore, most published evidence on TAVI in BAV comes from high-income countries, which may not reflect realities of underserved populations.

OBJECTIVES

Evaluate temporal trends, procedural, and in-hospital outcomes between BAV and tricuspid aortic valve (TAV) patients.

METHODS

Retrospective observational study based on a Brazilian multicenter registry of TAVI patients between January 2009 and December 2021. We performed propensity score matching to adjust comparisons. A p-value <0.05 was considered statistically significant for all analyses.

RESULTS

Among 2,426 patients from 25 centers, 111 had BAV. TAVI procedures increased over time in both groups. After one-to-three matching, 90 BAV and 243 TAV patients were included. No significant differences were observed in rates of major vascular complications (4% vs. 5%; p=0.99), major or life-threatening bleeding (10% vs. 6%; p=0.34), stroke (2% vs. 0.4%; p=0.37), or in-hospital mortality (7% vs. 3%; p=0.21). Over time, there was a significant reduction in in-hospital mortality (p<0.01) and major procedural complications (p<0.01 for vascular, bleeding, and stroke events), regardless of valve type.

CONCLUSION

During the study period, annual TAVI procedures increased in both BAV and TAV patients, although the prevalence of BAV remained relatively low. No significant differences were observed in procedural or clinical outcomes between the propensity-matched groups. Both valve types showed reductions in procedural complications and in-hospital mortality over time.