DOI: 10.1177/02676591261460654 ISSN: 0267-6591

Safety and efficacy of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in patients with bicuspid aortic stenosis: A Systematic review and meta-analysis

Ahmed Farid Gadelmawla, Ahmed Mansour, Ahmed Elbataa, Osama Hamdi Asiri, Amnah Ali Alharbi, Fatimah Ashraf Alquraish, Fatem Saleh Al-Ibrahim, Abdulaziz Fahad AlHasani, Turki Nashi Alharbi, Ruba Mohammed AL Murayyi, Abdulelah Ghazi Alotaibi, Hamza A. Abdul-Hafez, Ihab Suliman
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Background

Bicuspid aortic valve (BAV) disease is a leading cause of aortic stenosis (AS). Surgical aortic valve replacement (SAVR) has traditionally been regarded as the best therapeutic option for bicuspid AS. However, the distinctive anatomical characteristics of BAV make the treatment with transcatheter aortic valve replacement (TAVR) challenging, so this population was often excluded from the trials. We aimed to compare TAVR and SAVR in terms of safety and efficacy in the population with bicuspid AS.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, searched from PubMed, Cochrane, Scopus, and Web of Science (from inception until September 2025). Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes as mean differences (MDs), each with 95% confidence intervals (CIs).

Results

A total of 78,677 patients were included in one RCT, 12 retrospective cohort studies, and one prospective cohort study. TAVR, compared to SAVR, was associated with significantly higher rates of permanent pacemaker implantation (PPI) (O.R. = 2.29, 95% C.I. [1.51, 3.47], P < 0.01) and shorter length of hospital stay (M.D. = −2.24, 95% C.I. [-3.96, −0.52], P = 0.01) and lower bleeding rates (O.R. = 0.31, 95% C.I. [0.14, 0.69], P < 0.01). However, there were no significant differences in all-cause mortality (ACM) ( P = 0.948 ), acute kidney injury (AKI) (P = 0.28) , stroke incidence ( P = 0.475 ), and vascular complications (P = 0.31). The PPI and stroke rate results were consistent during in-hospital and short-term follow-ups. However, subgroup analysis by follow-up duration revealed that long-term stroke incidence was significantly higher in the TAVI group.

Conclusion

TAVR offers benefit by minimizing significant bleeding and hospital length of stay. However, the benefits should be balanced against the considerably increased risk of PPI and PVL. Further RCTs are needed to confirm these findings.

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