Up to 7-Year Follow-up of Bicuspid Aortic Valves (BAV) Undergoing TAVI versus Surgical Aortic Valve Replacement (SAVR)

Objectives: Recently many groups have reported their results with TAVI in bicuspid aortic valves and have pointed out technical challenges in this patient population. The aim of this study was to compare clinical outcomes of bicuspid aortic valves; in TAVI vs. surgical aortic valve replacement in an up to 7-year follow-up.

Methods: Between January 2011 and December 2014, a total of 2,506 patients with aortic stenosis underwent aortic valve replacement in our institution. 1,515 patients had a surgical aortic valve replacement and 991 patients had a TAVI procedure. In this cohort of patients, there were 104 bicuspid aortic valves (BAV) identified (SAVR = 52 vs. TAVI = 52). The diagnosis of BAV was made preoperatively by CT scan, echocardiography, or intraoperatively. Clinical endpoints were procedural and postoperative complications. Mean follow-up was 5 ± 2.82 years.

Results: Postoperative complications with the need for a secondary intervention were higher in the TAVI group 36.53% (n = 19) vs. 19.23% (n = 10) (vascular complications, pacemaker and conversion/ re-sternotomy). Significantly more patients in the TAVI group had a stroke postoperatively; 25% (n = 13) vs. 7, 69% (n = 4); p = 0.011. Residual aortic regurgitation > grade II was significantly higher in the TAVI group (21.2 vs. 0%).

Thirty-day mortality was lower in the SAVR group, 1.92% (n = 1) vs. 7.69% (n = 4), also the 5-year follow-up was lower in the SAVR group, 5.7% (n=3), then in the TAVI group, 46.30% (n = 24).

Conclusions: Treatment of BAV with TAVI bears significant procedural challenges. It may be an alternative treatment option for high-risk patients with BAV. In our study TAVI had significantly higher rates of mortality and procedural complications. Since the cohort was small, a randomized trial would lead to more conclusive results.