Acta cardiologica · 2026
Safety and efficacy of transcatheter aortic valve implantation in bicuspid aortic valve stenosis: a propensity-matched multicentre study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Assal Abdelrahman, Zaki Amr, Loutfi Mohamed, Mostafa Ahmad Elsayed
Аннотация
BACKGROUND: Current evidence regarding transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) is primarily based on Western registries, whereas data from Africa and the Middle East are scarce.
OBJECTIVES: To assess the safety and efficacy of contemporary TAVI in patients with BAV, in comparison with tricuspid aortic valve (TAV).
METHODS: This prospective multicenter observational study included consecutive patients undergoing TAVI between June 2021 and June 2024 at two tertiary centers in Egypt. Patients were classified as BAV (n = 50) or TAV (n = 267). Outcomes were adjudicated in accordance with Valve Academic Research Consortium-3 (VARC-3) criteria, with follow-up extending to 12 months. Propensity score (PS) matching (1:1) was applied to achieve balance in baseline characteristics.
RESULTS: Compared to TAV, BAV anatomy was associated with higher transvalvular gradients (p = 0.024), larger ascending aortic diameters (p < 0.001), greater leaflet calcification, and a higher prevalence of basal septal calcification (p = 0.006). Balloon pre-dilatation (86% vs. 38%) and post-dilatation (50% vs. 20%) were more frequently performed in BAV patients (both p < 0.001). Device success at 30 days was comparable between groups (84% in TAV vs. 92% in BAV, p = 0.357). The incidence of all-cause mortality, stroke, and new permanent pacemaker (PPM) implantation at 1 year did not differ meaningfully between groups.
CONCLUSIONS: In this prospective multicenter cohort, contemporary TAVI achieved early and mid-term outcomes in carefully selected BAV patients comparable to tricuspid anatomy. These findings suggest the feasibility of TAVI in carefully selected BAV anatomies when guided by detailed computed tomography (CT)-based assessment and tailored procedural planning.
OBJECTIVES: To assess the safety and efficacy of contemporary TAVI in patients with BAV, in comparison with tricuspid aortic valve (TAV).
METHODS: This prospective multicenter observational study included consecutive patients undergoing TAVI between June 2021 and June 2024 at two tertiary centers in Egypt. Patients were classified as BAV (n = 50) or TAV (n = 267). Outcomes were adjudicated in accordance with Valve Academic Research Consortium-3 (VARC-3) criteria, with follow-up extending to 12 months. Propensity score (PS) matching (1:1) was applied to achieve balance in baseline characteristics.
RESULTS: Compared to TAV, BAV anatomy was associated with higher transvalvular gradients (p = 0.024), larger ascending aortic diameters (p < 0.001), greater leaflet calcification, and a higher prevalence of basal septal calcification (p = 0.006). Balloon pre-dilatation (86% vs. 38%) and post-dilatation (50% vs. 20%) were more frequently performed in BAV patients (both p < 0.001). Device success at 30 days was comparable between groups (84% in TAV vs. 92% in BAV, p = 0.357). The incidence of all-cause mortality, stroke, and new permanent pacemaker (PPM) implantation at 1 year did not differ meaningfully between groups.
CONCLUSIONS: In this prospective multicenter cohort, contemporary TAVI achieved early and mid-term outcomes in carefully selected BAV patients comparable to tricuspid anatomy. These findings suggest the feasibility of TAVI in carefully selected BAV anatomies when guided by detailed computed tomography (CT)-based assessment and tailored procedural planning.