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Transcatheter aortic valve replacement (TAVR) is considered safe and feasible among high to intermediate risk tricuspid aortic valve (TAV) stenosis patients. Bicuspid aortic valve (BAV) stenosis treated with TAVR is under investigated and there is a paucity of data comparing TAVR outcomes between TAV and BAV. We aimed to evaluate the global experience with a meta-analysis of all clinical studies comparing BAV to TAV.
Pub Med and Cochrane databases were systematically searched for clinical studies comparing procedural and clinical outcomes of patients with severe BAV or TAV stenosis who underwent TAVR. Primary outcomes included 30 days mortality, procedure failure and ≥ 2 paravalvular leaking. Secondary outcomes included pacemaker implantation, neurological events, AMI, bleeding, conversion to open heart surgery, mean aortic gradient post-TAVR. We used fixed (I2 < 55%) otherwise random effect analysis using the Cochrane Handbook of Systematic Reviews.
Four studies were included in the analysis and provided a total 3067 patients (633=BAV and 2434=TAV). Primary endpoints analysis showed significant less procedural failure in TAV compared to BAV (3.2% vs. 13%; p<0.01). There was a trend towards less ≥ 2 paravalvular leaking in the TAV group compared to BAV (14% vs. 13%, p<0.05). There was no mortality difference between TAV and BAV groups (7.7% vs. 4.4%; p=0.5). Secondary endpoint analysis showed significant more conversion to open heart surgery in the BAV group compared to TAV (2% vs. 0.4%, p<0.01). There was no difference in pacemaker implantation, neurological events, AMI and bleeding.
Our analysis suggested that TAVR among patient with BAV stenosis might be clinically safe although it might be associated with higher procedural challenges given the less favorable procedural outcomes. Newer TAVR devices and expansion of the population studied (low-risk) might help to surmount these challenges.
STRUCTURAL: Congenital and Other Structural Heart Disease