TAVR for bicuspid, tricuspid aortic valve stenosis confers similar outcomes up to 1 year
Patients who underwent transcatheter aortic valve replacement had similar rates of stroke and all-cause mortality at 30 days and 1 year regardless of whether they had bicuspid or tricuspid aortic valve stenosis, researchers reported.
“This study suggests TAVR is a viable option for patients with bicuspid valve disease who are at increased surgical risk,” John K. Forrest, MD, director of the structural heart disease program at Yale University School of Medicine and Yale New Haven Hospital, said in a press release. “It will be very important to continue to monitor these patients to see how the valves perform in 10 or 15 years.”
In a study published in JACC: Cardiovascular Interventions, researchers analyzed data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry of patients who underwent TAVR with one of two self-expanding transcatheter valves (Evolut R or Evolut PRO, Medtronic) between July 2015 and September 2018. Patients either had bicuspid (n = 932; mean age, 73 years; 55% men) or tricuspid aortic valve stenosis (n = 26,154; mean age, 81 years; 47% men).
Data assessed in the hospital and at 30 days and 1 year after TAVR include baseline characteristics, medical history, demographics, outcomes and procedural characteristics.
Compared with patients with tricuspid aortic valve stenosis, those with bicuspid aortic valve stenosis were more likely to have a lower STS Predicted Risk of Mortality score (5.3% vs. 6.9%; P < .001), were younger and had fewer cardiac comorbidities including hypertension, peripheral vascular disease, diabetes and prior coronary revascularization.
Propensity matching was performed to account for differences in baseline characteristics. This resulted in 929 pairs to compare outcomes after TAVR in patients with bicuspid aortic valve stenosis or tricuspid aortic valve stenosis. Patients with bicuspid or tricuspid aortic valve stenosis had comparable rates of all-cause mortality at 30 days (2.6% vs. 1.7%, respectively; P = .18) and 1 year (10.4% vs. 12.1%, respectively; P = .63). These similarities were also observed in the incidence of stroke at 30 days (3.4% vs. 2.7%, respectively; P = .41) and 1 year (3.9% vs. 4.4%; P = .93).
Kansas City Cardiomyopathy Questionnaire scores increased from baseline to 1 year after TAVR by 32 points or more in each group (P < .001 for both). Most patients with bicuspid or tricuspid aortic valve stenosis also improved in NYHA functional class at 1 year (75.1% and 78.7%, respectively; P = .35).
“Given intrinsic differences in bicuspid and tricuspid aortic valve anatomies and a lack of data around low-risk patients with bicuspid aortic valves, randomized studies evaluating TAVR in low-risk patients with bicuspid aortic valve disease are needed,” Forrest and colleagues wrote.