Transcatheter aortic valve replacement (TAVR) is a safe, effective treatment for patients with bicuspid valves, according to research published in JACC: Cardiovascular Interventions.
“Numerous large-scale and randomized clinical trials have demonstrated the safety and effectiveness of TAVR as compared with surgical aortic valve replacement,” wrote lead author John K. Forrest, MD, director of the Structural Heart Disease Program at Yale University School of Medicine and Yale New Haven Hospital, and colleagues. “Based on these data, TAVR has now been approved as a therapy for patients with severe symptomatic aortic stenosis, regardless of their surgical risk profile. However, in all these trials, patients with bicuspid disease were excluded, and as such, data for patients with bicuspid aortic valve disease undergoing TAVR is limited.”
Forrest et al. explored data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, focusing on patients with bicuspid aortic valve stenosis who underwent elective TAVR. Patients received transcatheter valves from July 2015 to September 2018. Results from that study cohort—which totaled 932 patients—was then compared to more than 26,0000 patients with tricuspid aortic stenosis who underwent elective TAVR during the same time frame.
The authors performed propensity matching, leading to 929 matched pairs between patients with bicuspid valves and tricuspid valves, and found that the outcomes were quite similar. The rate of all-cause mortality after 30 days, for instance, was 2.6% for the bicuspid group and 1.7% for the tricuspid group. Stretching that out to one full year, all-cause mortality rates were still similar: 10.4% for the bicuspid group and 12.1% for the tricuspid group. Stroke rates after 30 days and one year were also comparable.
“This study suggests TAVR is a viable option for patients with bicuspid valve disease who are at increased surgical risk,” Forrest said in a statement. “It will be very important to continue to monitor these patients to see how the valves perform in 10 or 15 years.”