Long-Term Durability of Transcatheter Aortic Valve Prostheses in Patients With Bicuspid Versus Tricuspid Aortic Valve

Abstract

Background: Currently, there is a lack of evidence for the long-term bioprosthetic valve durability of patients with bicuspid aortic valve (BAV) following transcatheter aortic valve replacement (TAVR).

Methods and results: This study aimed to evaluate hemodynamic outcome, structural valve deterioration, and bioprosthetic valve failure during long-term follow-up after TAVR in patients with BAV versus patients with tricuspid aortic valve (TAV). Patients with BAV and TAV who underwent TAVR between 2012 and 2020, with echocardiography followed for at least 3 years, were included. Baseline characteristics, long-term valve hemodynamic performance, structural valve deterioration, and bioprosthetic valve failure were compared between patients with BAV and TAV. A total of 170 patients with BAV and 145 patients with TAV were included. The mean duration of follow-up for patients with BAV and TAV was 5.2±1.8 and 5.0±1.7 years. No significant differences were observed in the rates of structural valve deterioration and bioprosthetic valve failure between patients with BAV and TAV: structural valve deterioration, BAV 20 (11.8%) versus TAV 16 (11.0%) at last follow-up (P=0.861); bioprosthetic valve failure, BAV 3 (1.8%) versus TAV 7 (4.8%) at last follow-up (P=0.196). More than moderate intravalvular aortic regurgitation (1.8% versus 4.8%, P=0.196) and paravalvular leak (6.5% versus 3.4%, P=0.305) were rare in both patients with BAV and patients with TAV.

Conclusions: This study indicated satisfactory long-term valve durability of TAVR in patients with BAV. Comparable hemodynamic outcome, structural valve deterioration, and bioprosthetic valve failure could be achieved in patients with BAV and TAV during long-term follow-up after TAVR.

Keywords: bicuspid aortic valve; structural valve degeneration; transcatheter aortic valve replacement; valve durability.

Figure 1. Study flowchart.

The data show that, between 2012 and 2020, a total number of patients undergoing TAVR who were followed for ≥3 years had echo data available, and 18 patients were excluded, while 315 patients were included in the final analysis. CT indicates computed tomography; and TAVR, transcatheter aortic valve replacement.

Figure 2. Mean transprosthetic gradient and maximum aortic valve velocity development over time in the overall population.

Hemodynamic changes during follow‐up are shown in patients with BAV and patients with TAV. P value was calculated to assess the statistical significance of differences between the patients with BAV and TAV at each follow‐up. A, Mean transprosthetic gradient. B, Maximum aortic valve velocity. BAV indicates bicuspid aortic valve; TAV, tricuspid aortic valve; and TAVR, transcatheter aortic valve replacement.

Figure 3. Severity AR at baseline and follow‐up in overall population.

The severity of paravalvular leak and intravalvular AR are shown separately at baseline and at last follow‐up in patients with BAV and TAV. A, Paravalvular leak. B, Intravalvular AR. AR indicates aortic regurgitation; BAV, bicuspid aortic valve; and TAV, tricuspid aortic valve.

Figure 4. Cumulative incidence function of structural valve deterioration according to the competing risk analysis including the risk of death.

No statistically significant difference was found in the incidence of structural valve deterioration between patients with BAV and TAV during long‐term follow‐up. BAV indicates bicuspid aortic valve; TAV, tricuspid aortic valve; and TAVR, transcatheter aortic valve replacement.

Figure 5. Cumulative incidence function of bioprosthesis valve failure according to the competing risk analysis including the risk of death.

There was no statistical difference in bioprosthetic valve failure between patients with BAV and TAV through 7 years of follow‐up after procedure. BAV indicates bicuspid aortic valve; and TAV, tricuspid aortic valve.