Among patients with Sievers type 1 bicuspid aortic valve stenosis undergoing TAVI, mixed BAV disease was associated with a lower risk of major adverse events compared to pure BAV stenosis (HRadj 0.47; 95% CI 0.25-0.85; P=0.013).
Cohort (n=956)
Yes
Does the presence of moderate or severe baseline aortic regurgitation improve outcomes in patients with severe Sievers type 1 bicuspid aortic valve stenosis undergoing TAVI?
In patients with Sievers type 1 bicuspid aortic valve stenosis undergoing TAVI, the presence of moderate or severe baseline aortic regurgitation is associated with a significantly lower risk of major adverse events.
Effect estimate: HRadj 0.47 (95% CI 0.25-0.85)
Absolute Event Rate: 9% vs 17.5%
p-value: p=.013
INTRODUCTION AND OBJECTIVES In patients with tricuspid aortic valve stenosis, the coexistence of aortic regurgitation (AR) at baseline has been associated with improved outcomes following transcatheter aortic valve implantation (TAVI). However, its prognostic impact in patients with bicuspid aortic valve (BAV) stenosis remains unknown. METHODS We enrolled consecutive patients with severe Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers. Patients were stratified into 2 groups according to baseline AR severity: pure BAV stenosis (ie, no or mild AR) and mixed BAV disease (ie, moderate or severe AR). Clinical outcomes were compared using adjusted Cox models. The primary endpoint was major adverse events (MAE), defined as a composite of all-cause death, cerebrovascular events, or hospitalization for heart failure. RESULTS A total of 956 patients were included, of whom 134 (14%) had mixed BAV disease and 822 (86%) had pure BAV stenosis. At a median follow-up of 1.2 0.4-2.2 years, patients with mixed BAV disease had a lower risk of MAE compared with those with pure BAV stenosis (9.0% vs 17.5%; adjusted hazard ratio HRadj, 0.47; 95%CI, 0.25-0.85; P = .013), mainly driven by a significantly lower risk of all-cause death (6.0% vs 12.0%; HRadj, 0.44; 95%CI, 0.21-0.92; P = .029). CONCLUSIONS Among patients with Sievers type 1 BAV stenosis undergoing TAVI, those with mixed BAV disease had a lower risk of MAE than those with pure BAV stenosis.
Zito et al. (Sun,) conducted a cohort in Severe Sievers type 1 bicuspid aortic valve stenosis (n=956). Mixed BAV disease (moderate or severe AR) vs. Pure BAV stenosis (no or mild AR) was evaluated on Major adverse events (MAE), defined as a composite of all-cause death, cerebrovascular events, or hospitalization for heart failure (HRadj 0.47, 95% CI 0.25-0.85, p=.013). Among patients with Sievers type 1 bicuspid aortic valve stenosis undergoing TAVI, mixed BAV disease was associated with a lower risk of major adverse events compared to pure BAV stenosis (HRadj 0.47; 95% CI 0.25-0.85; P=0.013).