Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Sung-Han Yoon, Sabine Bleiziffer, Ole De Backer, Victoria Delgado, Takahide Arai, Johannes Ziegelmueller, Marco Barbanti, Rahul Sharma, Gidon Y. Perlman, Omar K. Khalique, Erik W. Holy, Smriti Saraf, Florian Deuschl, Buntaro Fujita, Philipp Ruile, Franz-Josef Neumann, Gregor Pache, Masao Takahashi, Hidehiro Kaneko, Tobias Schmidt, Yohei Ohno, Niklas Schofer, William K.F. Kong, Edgar Tay, Daisuke Sugiyama, Hiroyuki Kawamori, Yoshio Maeno, Yigal Abramowitz, Tarun Chakravarty, Mamoo Nakamura, Shingo Kuwata, Gerald Yong, Hsien-Li Kao, Michael Lee, Hyo-Soo Kim, Thomas Modine, S. Chiu Wong, Francesco Bedgoni, Luca Testa, Emmanuel Teiger, Christian Butter, Stephan M. Ensminger, Ulrich Schaefer, Danny Dvir, Philipp Blanke, Jonathon Leipsic, Fabian Nietlispach, Mohamed Abdel-Wahab, Bernard Chevalier, Corrado Tamburino, David Hildick-Smith, Brian K. Whisenant, Seung-Jung Park, Antonio Colombo, Azeem Latib, Susheel K. Kodali, Jeroen J. Bax, Lars Søndergaard, John G. Webb, Thierry Lefèvre, Martin B. Leon, Raj Makkar

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is being increasingly performed. From the Bicuspid AS TAVR multicenter registry, the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS were compared. Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity-score matching assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to VARC-2 criteria. Compared to patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p=0.006) and significantly lower device success rate (85.3% vs. 91.4%; p=0.002). Early generation devices (Sapien XT/CoreValve) were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS whereas new generation devices (Sapien 3/Lotus/Evolut R) were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p=0.015) when receiving the Sapien XT, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p=0.02) when receiving the CoreValve. Among patients with new generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2-year were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p=0.28). Compared to tricuspid AS, TAVR in bicuspid AS was associated with similar prognosis although lower device success rate. Procedural differences were observed in patients treated with the early generation devices whereas no differences were observed with the new generation devices.