TAVI in young patients with bicuspid aortic valve stenosis: insight from the international AD-HOC registry.

Abstract

BACKGROUND: Evidence regarding transcatheter aortic valve implantation (TAVI) in young (<= 75 years) low-risk patients with bicuspid aortic valve (BAV) stenosis deemed unsuitable for surgery is scarce. OBJECTIVES: To investigate in-hospital and follow-up outcomes in this population compared with older or higher-risk patients. METHODS: This retrospective international registry included 980 patients with severe BAV stenosis undergoing TAVI, stratified in: Group I, < 69 years and Society of Thoracic Surgeons predicted mortality (STS-PROM) < 4 (N = 113); Group II, 69-75 years and STS-PROM < 4 (N = 173); Group III, > 75 years or STS-PROM >= 4 (N = 694). Endpoints included technical success, 30-day device success and safety, transcatheter heart valve (THV) function during follow-up, survival and freedom from transient ischemic attack (TIA)/stroke or heart failure hospitalization. RESULTS: Technical success was comparable (Group I: 94.7%, Group II: 97.1%, Group III: 94.5%; P = 0.37), as were 30-day device success (P = 0.45) and safety (P = 0.29). Regression analyses revealed stable mean transvalvular gradients over follow-up with no differential temporal trends across groups (P = 0.93), and no association between follow-up time and PVL severity (P = 0.17); younger patients showed lower odds of mild PVL compared with older patients. Severe valve deterioration did not occur in Group I and II, versus 3 cases (0.4%) in Group III. Bioprosthesis valve failure rate remained < 2% and similar across groups (P = 0.53). Freedom from TIA/stroke or heart failure rehospitalization was higher in Group I (91.1%) and II (93.8%) than in Group III (81.0%, P = 0.006). CONCLUSIONS: TAVI in young, low-risk BAV patients deemed unsuitable for surgery showed favorable in-hospital outcomes comparable to those of older or higher-risk patients, with stable valve hemodynamics during follow-up.