Midterm Clinical and Echocardiographic Outcomes After Transcatheter Aortic Valve Replacement in Patients With Severe Bicuspid Aortic Valve Stenosis.

BACKGROUND: Outcomes >2 years after transcatheter aortic valve replacement (TAVR) for bicuspid aortic valves (BAV) are scarce, and differences between balloon-expandable transcatheter heart valves (THVs) and self-expandable (SE-THVs) are not yet well established.

METHODS: This study aims to report midterm outcomes after TAVR in patients with BAV and includes 92 patients undergoing TAVR for BAV stenosis at the University Hospital Cologne between 2018 and 2023. The primary outcomes were all-cause death, cardiovascular death, and stroke over a mean follow-up of 2.9 years.

RESULTS: Among 92 consecutive patients undergoing TAVR for BAV stenosis (median age: 78.8 years), the incidence of all-cause death, cardiovascular death, and stroke was 26.1%, 18.5%, and 14.1%, respectively, at 2.9 years, with no differences between balloon-expandable THVs and SE-THVs. Pacemaker implantation tended to be more frequent in the SE-THV group. Periprocedural complications were rare, as reflected by a high Valve Academic Research Consortium-3 technical success rate of 96.7%. Postprocedural transvalvular gradients were favorable, with SE-THV showing lower values than balloon-expandable THV (8.0 versus 10.5 mm Hg, P=0.007). Moderate or severe paravalvular regurgitation was uncommon, with no differences between groups, although a trend toward more relevant paravalvular regurgitation with SE-THV was observed.

CONCLUSIONS: TAVR for BAV is feasible with both SE-THV and balloon-expandable -THV, achieving high technical success and low complication rates. Hemodynamic differences were observed, but mortality and stroke did not differ significantly between groups. Overall outcomes remain suboptimal, highlighting the need for randomized trials comparing valve types and TAVR with surgery for patients with BAV.