Three‐year clinical outcomes after transcatheter aortic valve implantation in patients with bicuspid aortic disease: Comparison between self‐expanding and balloon‐expandable valves

Abstract

AbstractIntroductionBicuspid aortic valve (BAV) stenosis is a complex anatomical scenario for transcatheter aortic valve implantation (TAVI). Favorable short‐term clinical outcomes have been reported with TAVI in this setting, but long‐term data are scarce.MethodsWe retrospectively included, in a single‐center registry, patients with BAV stenosis who underwent TAVI before 2020. We compared patients treated with self‐expanding valves (SEV) versus balloon‐expandable valves (BEV). The primary endpoint was a composite of all‐cause mortality, stroke and need for aortic valve (AV) reintervention at 3 years. Secondary endpoints included each component of the primary endpoint, cardiovascular mortality, permanent pacemaker implantation (PPI) rate, mean gradient and ≥moderate paravalvular leak (PVL) rate.ResultsA total of 150 consecutive patients (SEV = 83, BEV = 67) were included. No significant differences were reported between SEV and BEV groups for the primary composite endpoint (SEV 35.9% vs. BEV 32%, p = 0.66), neither for clinical secondary endpoints (all‐cause mortality SEV 28.1% vs. BEV 28%, p = 0.988; cardiovascular mortality SEV 14.1% vs. BEV 20%, p = 0.399; stroke SEV 12.5% vs. BEV 6%, p = 0.342; need for AV reintervention SEV 0% vs. BEV 0%; PPI SEV 28.1% vs. BEV 24%, p = 0.620). A lower mean gradient persisted up to 3 years in the SEV group (SEV 8.8 ± 3.8 mmHg vs. BEV 10.7 ± 3.2 mmHg, p = 0.063), while no significant difference was found in the rate of ≥ moderate PVL (SEV 3/30 vs. BEV 0/25, p = 0.242).ConclusionsIn this single center registry, we observed favorable 3‐year clinical outcomes in nonselected BAV patients treated with different generation devices, without significant differences between patients receiving SEV or BEV.