Transcatheter versus surgical aortic valve replacement in bicuspid aortic stenosis: baseline characteristics and early clinical outcomes
C Santos Jorge, D Correia Silva, M Presume, R Barbosa Sousa, S Azevedo, R Carvalho, M Madeira, T Nolasco, J Brito, R Campante Teles, M AlmeidaAbstract
Background
Transcatheter aortic valve implantation (TAVI) has become a less invasive alternative to surgical aortic valve replacement (SAVR) for severe aortic stenosis, particularly in elderly or high-risk patients. This study aimed to assess clinical characteristics, procedural performance, and early outcomes of TAVI versus SAVR in patients with bicuspid aortic valve stenosis.
Methods
A retrospective, single-center analysis included 118 consecutive patients treated between 2015 and 2017: 70 undergoing TAVI and 48 SAVR. Baseline demographics, imaging data, periprocedural complications, and early outcomes were compared.
Results
TAVI patients were older (81.4±4.4 vs. 73.2±11.2 years, p<0.001) and had more comorbidities, including chronic kidney disease (84% vs. 31%, p<0.001), chronic pulmonary disease (13% vs. 0%, p=0.010), and permanent atrial fibrillation (19% vs. 2.1%, p=0.023). They showed higher surgical risk (EuroSCORE 3.31 [2.3–4.1] vs. 1.74 [1.3–2.8], p<0.001), lower hemoglobin (12.6 [11.6–13.8] vs. 14 [12.5–14.5] g/dL, p=0.001), and higher NT-proBNP (1570 [659–4462] vs. 459 [193–1474] pg/mL, p=0.008). LVEF was lower in TAVI (55 [51–60] vs. 65 [55–65], p<0.001) and AVA smaller (0.62 [0.5–0.8] vs. 0.7 [0.6–0.9] cm², p=0.027). Technical success at the end of the procedure was high and comparable between groups (TAVI 95.7% vs. SAVR 89.6%, p = 0.193). Similarly, device success at 30 days did not differ significantly (TAVI 75.7% vs. SAVR 79.2%, p = 0.239). However, moderate-to-severe paravalvular leak (15.9% vs. 0%, p=0.004), complete atrioventricular block (21.4% vs. 2.1%, p=0.009), and pacemaker implantation (22.9% vs. 6.3%, p=0.016) occurred more frequently in the TAVI cohort. No significant differences were observed in stroke (2.9% vs. 0%, p=0.238) or in-hospital mortality (4,3% vs. 0%, p=0.150).
Conclusions
Compared with SAVR, TAVI patients were older, had greater comorbidity and risk scores, and achieved high procedural success with shorter hospitalization, albeit with higher rates of conduction disturbances and paravalvular leak.For image description, please refer to the figure legend and surrounding text.