TAVI associated with reduced odds of in-hospital mortality for bicuspid valve patients

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A propensity score-matched analysis of the early outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve stenosis patients compared with surgical valve replacement has found that TAVI was associated with reduced odds of in-hospital mortality.

The study supports the feasibility of TAVI in bicuspid valve patients without a need for concurrent aortic root repair, researcher Monil Majmundar (Maimonides Medical Center, New York, USA) writes in EuroIntervention.

Majmundar and colleagues report that there is limited information available on outcomes in patients with bicuspid aortic valve stenosis undergoing either TAVI or surgical aortic valve implantation (SAVR), as randomised trials have typically excluded patients with bicuspid aortic valve pathology due to anatomic complexity. The study team, therefore, aimed to compare early outcomes between TAVI and SAVR in these patients.

Researchers queried the Nationwide Readmission Database (NRD) between 2016 and 2018 to identify adults who underwent TAVI or SAVR for secondary valve stenosis. The primary outcome was in-hospital mortality, while secondary outcomes included 30-day mortality and six-month major adverse cardiovascular events (MACE).

The study team matched both cohorts using propensity score matching and applied logistic and Cox-proportional hazard regression to compute the odds ratio (OR), hazard ratio (HR) and the 95% confidence interval (CI).

Majmundar et al report that of the 17,068 patients with bicuspid aortic stenosis, 1,629 (9.5%) underwent TAVI, compared to 15,439 (90.5%) who underwent surgical valve replacement.

After propensity score matching, the researchers found 1,393 matched pairs, of which 848 had complete six-month follow-ups. In the propensity-matched cohort, TAVI was associated with reduced in-hospital mortality (0.7% vs. 1.8%, OR: 0.35, 95% CI: 0.13‒0.93; p=0.035), and a similar rate of MACE at 30 days (1% vs. 1.5%, OR: 0.65, 95% CI: 0.27‒1.58; p=0.343) and at six months (4.2% vs 4.9%, HR 0.86, 95% CI: 0.44‒1.69; p=0.674), compared with SAVR. Moreover, TAVI was associated with lower in-hospital morbidities, and shorter length of stay. There were no differences in short-term and medium-term mortality, stroke, cardiovascular hospitalisation, and readmission. However, TAVI was associated with a higher pacemaker implantation rate than SAVR in patients with bicuspid aortic valve stenosis.

These results led the study team to conclude that TAVI was associated with reduced odds of in-hospital mortality and a similar risk of 30-day and six-month MACE, supporting the feasibility of TAVI in bicuspid aortic valve patients without a need for concurrent aortic root repair.


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