Safety and efficacy of transcatheter aortic valve implantation in stenotic bicuspid aortic valve compared to tricuspid aortic valve: a systematic review and meta-analysis

ABSTRACT

Background

Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgical replacement for tricuspid aortic valve (TAV) stenosis. However, utilization of TAVI for aortic stenosis in bicuspid aortic valve (BAV) compared to TAV remains controversial.

Methods

We queried online databases with various keywords to identify relevant articles. We compared major cardiovascular events and procedural outcomes using a random effect model to calculate odds ratios (OR).

Results

We included a total of 22 studies comprising 189,693 patients (BAV 12,669 vs. TAV 177,024). In the pooled analysis, there were no difference in TAVI for BAV vs. TAV for all-cause mortality, cardiovascular mortality, myocardial infarction (MI), vascular complications, acute kidney injury (AKI), coronary occlusion, annulus rupture, and reintervention/reoperation between the groups. The incidence of stroke (OR 1.24; 95% CI 1.1–1.39), paravalvular leak (PVLR) (OR 1.42; 95% CI 1.26–1.61), and the need for pacemaker (OR 1.15; 95% CI 1.06–1.26) was less in the TAV group compared to the BAV group, while incidence of life-threatening bleeding was higher in the TAV group. Subgroup analysis mirrored pooled outcomes except for all-cause mortality.

Conclusion

The use of TAVI for the treatment of aortic stenosis in selective BAV appears to be safe and effective.

KEYWORDS:

• Aortic stenosis
• AS
• bicuspid aortic valve
• BAV
• tricuspid aortic valve
• TAV
• transcatheter aortic valve implantation
• TAVI

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

Data was obtained from published articles on the topic. All data can be obtained from the references mentioned in the supplementary file. The consolidated extracted data are available on demand.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This paper was not funded.