Impact of Transcatheter Aortic Valve Replacement in Cases with Bicuspid Aortic Valve Stenosis Compared with Tricuspid Aortic Valve Stenosis

Background and Aim: Transcatheter aortic valve implantation (TAVI) is a well-established intervention for severe aortic stenosis (AS).The bicuspid aortic valve (BAV) continues to pose a technical challenge because of altered valve geometry, asymmetric calcification, and larger annular dimensions.Objectives to compare the early in-hospital clinical and procedural outcomes of TAVI in patients with bicuspid versus tricuspid aortic valve (TAV) stenosis using new-generation self-expanding Evolut R and Evolut PRO valves.We hypothesized that early in-hospital outcomes would be broadly comparable between the two groups despite the more complex bicuspid anatomy. Materials and Methods:This prospective observational cohort study enrolled 60 patients with significant symptomatic AS who underwent TAVI and were categorized by valve morphology into a BAV group (n=15) and a TAV group (n=45).Results: Diabetes mellitus was more prevalent in the TAV group than the BAV group (64.4% vs. 33.3%,P = 0.035; odds ratio 0.28, 95% confidence interval 0.08-0.95,favoring a lower prevalence in the BAV group).Annular dimensions, including the minimum, maximum, and mean annular diameters, the derived perimeter, and the annular area, were significantly larger in the BAV group (all P < 0.05).Post-procedural conduction abnormalities, complete heart block, atrial fibrillation, aortic regurgitation, and paravalvular leak did not differ significantly between groups.Mean and maximal pressure gradients after TAVI were significantly higher in the BAV group.Early adverse events were infrequent overall, with vascular complications and stroke occurring in 3.3% and 1.7% of the whole cohort, respectively, and did not differ significantly between groups.Conclusion: TAVI using contemporary self-expanding valves produced early in-hospital outcomes in BAV patients that were statistically comparable to those in TAV patients, despite significantly greater anatomical complexity, thereby supporting the feasibility of TAVI in carefully selected bicuspid patients.These early, hypothesis-generating findings from a two-center cohort warrant confirmation in larger, adequately powered, multicenter studies with longer follow-up.