Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis.

Abstract

OBJECTIVES:

The purpose of this study was to assess the temporal trends of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS), and to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) in this population.

BACKGROUND:

Randomized trials comparing TAVR to SAVR in AS with bicuspid valve are lacking.

METHODS:

The study queried the National Inpatient Sample database (years 2012 to 2016) to identify hospitalizations for bicuspid AS who underwent isolated aortic valve replacement. A propensity-matched analysis was used to compare outcomes of hospitalizations for TAVR versus SAVR for bicuspid AS and TAVR for bicuspid AS versus tricuspid AS.

RESULTS:

The analysis included 31,895 hospitalizations with bicuspid AS, of whom 1,055 (3.3%) underwent TAVR. TAVR was increasingly utilized during the study period for bicuspid AS (ptrend = 0.002). After matching, TAVR and SAVR had similar in-hospital mortality (3.1% vs. 3.1%; odds ratio: 1.00; 95% confidence interval: 0.60 to 1.67). There was no difference between TAVR and SAVR in the rates of cardiac arrest, cardiogenic shock, acute kidney injury, hemopericardium, cardiac tamponade, or acute stroke. TAVR was associated with lower rates of acute myocardial infarction, post-operative bleeding, vascular complications, and discharge to nursing facility as well as a shorter length of hospital stay. On the contrary, TAVR was associated with a higher incidence of complete heart block and permanent pacemaker insertion. TAVR for bicuspid AS was associated with similar in-hospital mortality compared with tricuspid AS.

CONCLUSIONS:

This nationwide analysis showed similar in-hospital mortality for TAVR and SAVR in patients with bicuspid AS. TAVR for bicuspid AS was also associated with similar in-hospital mortality compared with tricuspid AS. Further studies are needed to evaluate long-term outcomes of TAVR for bicuspid AS.

• Authors: Ayman Elbadawi, Marwan Saad, Islam Y Elgendy, Kirolos Barssoum, Mohamed A Omer, Ahmed Soliman, Mohamed F Almahmoud, Gbolahan O Ogunbayo, Amgad Mentias, Syed Gilani, Hani Jneid, Herbert D Aronow, Neil Kleiman, J Dawn Abbott
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 12 Issue 18 Pg. 1811-1822 (09 23 2019) ISSN: 1876-7605 [Electronic] United States
• PMID: 31537280 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Aortic Valve (abnormalities, diagnostic imaging, physiopathology, surgery)
• Aortic Valve Stenosis (diagnostic imaging, mortality, physiopathology, surgery)
• Bicuspid Aortic Valve Disease
• Databases, Factual
• Female
• Heart Valve Diseases (diagnostic imaging, mortality, physiopathology, surgery)
• Heart Valve Prosthesis Implantation (adverse effects, mortality, trends)
• Hospital Mortality (trends)
• Humans
• Incidence
• Inpatients
• Male
• Middle Aged
• Postoperative Complications (mortality, therapy)
• Risk Assessment
• Risk Factors
• Time Factors
• Transcatheter Aortic Valve Replacement (adverse effects, mortality, trends)
• Treatment Outcome
• United States (epidemiology)