NYMC Faculty Publications

Clinical Outcomes and the Impact of Valve Morphology for Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis

Rahul Gupta, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
Elham Mahmoudi, Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran.
Amir Hossein Behnoush, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Aaqib H. Malik, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
Pranav Mahajan, Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA.
Muling Lin, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Dhrubajyoti Bandyopadhyay, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
Akshay Goel, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
Sandipan Chakraborty, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
Surya K. Aedma, Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA.
Harsh Bala Gupta, Guru Nanak Dev Hospital, Department of medicine, Government Medical College, Amritsar, Punjab, India.
Apurva V. Vyas, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
William G. Combs, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
Moses Mathur, Heart & Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Steven J. Yakubov, Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, Ohio, USA.
Nainesh C. Patel, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.

Author Type(s)

Faculty, Resident/Fellow

Journal Title

Catheterization and Cardiovascular Interventions

First Page

721

Last Page

730

Document Type

Article

Publication Date

10-1-2023

Department

Medicine

Abstract

BACKGROUND: Bicuspid aortic valve (BAV) is present in approximately 0.5%-2% of the general population, causing significant aortic stenosis (AS) in 12%-37% of affected individuals. Transcatheter aortic valve replacement (TAVR) is being considered the treatment of choice in patients with symptomatic AS across all risk spectra. AIM: Aim Our study aims to compare TAVR outcomes in patients with BAV versus tricuspid aortic valves (TAV). METHODS: A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane trials. Studies were included if they included BAV and TAV patients undergoing TAVR with quantitative data available for at least one of our predefined outcomes. Meta-analysis was performed by the random-effects model using Stata software. RESULTS: Fifty studies of 203,288 patients were included. BAV patients had increased 30-day all-cause mortality (odds ratio [OR] = 1.23 [1.00-1.50], p = 0.05), in-hospital stroke (OR = 1.39 [1.01-1.93], p = 0.05), in-hospital and 30-day PPI (OR = 1.13 [1.00-1.27], p = 0.04; OR = 1.16 [1.04-1.13], p = 0.01) and in-hospital, 30-day and 1-year aortic regurgitation (AR) (OR = 1.48 [1.19-1.83], p < 0.01; OR = 1.79 [1.26-2.52], p < 0.01; OR = 1.64 [1.03-2.60], p = 0.04). Subgroup analysis on new-generation valves showed a reduced 1-year all-cause mortality (OR = 0.86 [CI = 0.75-0.98], p = 0.03), despite higher in-hospital and 30-day PPI (OR = 0.1.21 [1.04-1.41], p = 0.01; OR = 1.17 [1.05-1.31], p = 0.01) and in-hospital AR (OR = 1.62 [1.14-2.31], p = 0.01) in the BAV group. The quality of included studies was moderate-to-high, and only three analyses presented high heterogeneity. CONCLUSION: TAVR is associated with comparable outcomes in patients with BAV and TAV. Careful selection of BAV cases by preprocedural assessment of valve anatomy and burden of calcification, pre- and post-procedural dilation, and implementing newer generations of valves may improve the safety and efficacy of TAVR in BAV patients.

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