Procedural and clinical outcomes of transcatheter aortic valve replacement in bicuspid aortic valve patients: a systematic review and meta-analysis

Abstract

Background: Currently, bicuspid aortic valve (BAV) anatomy remains a relative contraindication for transcatheter aortic valve replacement (TAVR) due to concerns of suboptimal anatomy. However, recent advancements in the field have provided a wealth of promising data and more clinicians are opting for TAVR as an alternative to surgical repair. We aim to review and analyze the available data for TAVR in BAV patients, targeting procedural outcomes, clinical outcomes and mortality with up to two years of follow-up.Methods: A literature search of five databases was performed and all primary studies published between 2002 and 2021 that reported procedural, clinical or mortality outcome data were identified. Following data extraction, a meta-analysis of means or proportions was performed using a random effects model. Heterogeneity was assessed using the I 2 statistic.Results: A total of 22 studies with 1,945 BAV patients were identified. The mean age was 74.1 years and 58.8% of patients were male. Device success rates was 87.5%. Moderate to severe paravalvular leak (PVL) was seen in 3.7% of procedures. Clinical outcomes included new permanent pacemaker insertion (PPI) (11.8%), major bleeding (3.5%), major vascular complications (2.5%), stroke (2.3%), acute kidney injury (2.1%) and coronary obstruction (0.1%). Mortality in hospital, at 30-days, one and two years of follow-up were 1.9%, 2.1%, 9.6% and 12.9%, respectively.Conclusions: This assessment of the available data on TAVR for BAV shows promising outcomes and low rates of complications. However, further research is warranted to reduce the heterogeneity of the available data and provide insight into outcomes beyond two years of follow-up.

A Rare but Deadly Complication of Transcatheter Aortic Valve Replacement

“…In the patient presented, a bicuspid aortic valve could have also contributed to DCO. A study of bicuspid aortic valve patients found the incidence of DCO after TAVR to be 0.1%, similar to that found in other studies including both bicuspid and tricuspid valve patients [ 15 ]. However, it has been shown that bicuspid aortic valves have a higher calcium burden compared to tricuspid valves [ 16 ].…”

Mid‐term outcomes and hemodynamic performance of transcatheter aortic valve implantation in bicuspid aortic valve stenosis: Insights from the bicuSpid TAvi duraBILITY (STABILITY) registry

“…Indeed, multicentre registries reported more favorable outcomes with the implementation of newer generation devices (Medtronic CoreValve Evolut R/PRO and Edwards Sapien 3), albeit in relatively small cohorts 13,14 . More contemporary evidence is obtained in terms of midterm clinical FU reporting the survival rate at 1 or 2 years 15 . Recently, Zhou et al compared 109 BAV with 137 TAV treated with TAVI reporting a similar 3‐year survival rate between two groups (87.1% vs. 79.5%, respectively, log‐rank p = 0.126) 16 .…”

“…13,14 More contemporary evidence is obtained in terms of midterm clinical FU reporting the survival rate at 1 or 2 years. 15 Recently, Zhou et al compared 109 BAV with 137 TAV treated with TAVI reporting a similar 3-year survival rate between two groups (87.1% vs. 79.5%, respectively, log-rank p = 0.126). 16 Recently published results from the BIVOLUTX registry demonstrated the favorable performance of Evolut PRO and Evolut R TAVI in patients with BAV anatomy.…”

A Comprehensive Review of Management Strategies for Bicuspid Aortic Valve (BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in Light of Recent Guidelines

“…Nonetheless, there remains a shortage of conclusive evidence regarding coronary and commissural alignment, as well as coronary access following TAVR in cases involving bicuspid valves. However, studies centred around bicuspid valves available in the literature suggest that TAVR can be effectively and safely performed with a quite low risk of coronary occlusion in such valve types [ 78 , 79 , 80 ]. Moreover, TAVR might serve as a viable alternative for individuals with bicuspid valves who are deemed unsuitable candidates for traditional surgical approaches [ 78 , 79 , 80 ].…”

“…However, studies centred around bicuspid valves available in the literature suggest that TAVR can be effectively and safely performed with a quite low risk of coronary occlusion in such valve types [ 78 , 79 , 80 ]. Moreover, TAVR might serve as a viable alternative for individuals with bicuspid valves who are deemed unsuitable candidates for traditional surgical approaches [ 78 , 79 , 80 ]. Notably, the 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease [ 68 ] designates TAVR as a class IIb recommendation, level of evidence B, under specific conditions for bicuspid patients.…”